It’s a lifesaver for men at high risk but not all need it: Urological body
THE Singapore Urological Association agrees with a recent recommendation by a United States panel that healthy men generally need not get a PSA blood test to screen for prostate cancer. However, the test should not be totally thrown out – it is still a lifesaver for those at high risk of the disease. Men with a family history of the cancer or who experience urinary abnormalities that are potential signs of the disease should take the test. In contrast, the recommendation by the United States Preventive Services Task Force, a non-governmental panel, was for healthy men of all ages to avoid the test completely. The reason it gave: The test does not save lives overall and often leads to more needless tests and treatments that cause pain and complications like incontinence. But the urological association said in a statement to The Straits Times: “To declare that the test is futile in a sweeping statement would be to ignore the benefit the test has conferred on countless men.” Beneficiaries include men who have had aggressive prostate cancer detected and survivors who depend on the test to check for recurrence of the ailment.
Prostate cancer is the third-most common cancer among men in Singapore after colorectal and lung, with about 500 new cases and 100 deaths yearly. A PSA test, which costs from $40, is advised for men aged between 50 and 75. The association noted that the public needs to differentiate between PSA screening and PSA testing. Screening is where all men of a certain age group go for the test, no matter how susceptible they are to the disease. Many clinics here include the PSA test in health-screening packages. Men can also ask for it even if they are not in a high-risk group.
Consultant urologist Chin Chong Min said only one in five whose readings fall into the danger zone actually turns out to have prostate cancer. Those who register high readings in the PSA test undergo a biopsy where tissue samples are taken to test for cancer. The association said the PSA test is more beneficial when done selectively. Dr Chin, who practises at Mount Elizabeth Medical Centre, said it is worth taking if one belongs to a high-risk group. Men with a family history of the disease, for example, are twice as likely to get prostate cancer, he added. Retiree William Huang, 67, benefited from the test. He was diagnosed with stage II prostate cancer after opting for his first-ever PSA test during a medical check-up in 2008. Dr Chin, who operated on him earlier this year, said the cancer would likely have spread to other parts of the body if it had not been detected early. Mr Huang, whose latest PSA test was clear, said: “If not for the test, who knows what would have happened to me by now?”
Another urologist, Dr Ho Siew Hong, said that while many tests had been tried out over the years, none rivals the PSA. “The problem now is that many people go for general health screening and they want everything,” said the senior consultant urologist, who practises at Gleneagles Medical Centre. For most hospitals, including the Singapore General Hospital and National University Hospital, the PSA test and other tests for cancer bio-markers are not automatically included in screening packages.
But patients can ask for them, said Dr Yuen Yih, director of SGH’s health assessment centre. He said the doctors will first explain to patients that the test may be of limited value. If they insist on going ahead, the clinic will oblige. Dr Ho believes that general practitioners and family physicians “are in a good position” to inform patients about the proper use of the PSA test. “Living a healthy life doesn’t mean going for a battery of tests every year,” he said.