When the prostate specific antigen (PSA) blood test became available in the 1990s, it revolutionized the ability to detect prostate cancer. Urologists such as Simon Kimm, M.D., of the Palo Alto Medical Foundation, could finally spot a disease that affected one in seven men at an earlier stage where treatment might be simpler and more effective. Along with the test came new advances in surgery and radiation therapy that let doctors target prostate cancers with increasing precision.
“This lead to a period of widespread and aggressive treatment of prostate cancer,” Dr. Kimm says. “Studies show this approach saved lives, but it also subjected many men to the side-effects of treatment.”
After skin cancer, prostate cancer is the most common cancer among men. Although it is a serious disease, it can often be treated successfully. More than 2 million men in the United States are prostate cancer survivors, according to the American Cancer Society.
“With a simple blood test to screen for prostate cancer and better methods for removing cancers, the conventional wisdom was that it was safest to assume every prostate cancer detected could be an aggressive, fast growing, deadly cancer and should be treated,” Dr. Kimm explains. “However, as the PSA test came into widespread use, data began to show that aggressive treatment for every prostate cancer might not be best for all men. Over the past ten years, we have learned from studies that a smaller number of prostate cancers behave very aggressively. Some pose more intermediate risk, and many are low risk and unlikely to be life-threatening. We also have learned that PSA alone is not always a good test for discriminating between these types of prostate cancers.”