HEALTH MATTERS: PSA testing for prostate cancer remains mired in controversy

• Dr. Joshua Wynne

Dr. Joshua Wynne

Talk about it

Q. I am an otherwise healthy 64-year-old man. Should I have a PSA test to look for prostate cancer?

A. There are few areas in medicine that are as controversial as this question. A while ago, I discussed the controversy surrounding the efficacy of mammography for breast cancer screening in younger women. The story with the PSA test is even more contested. PSA stands for prostate-specific antigen; it is a blood test that that can identify men who harbor prostate cancer. Initial enthusiasm for the test has receded as the benefits of testing have been questioned and the side effects of therapy (including impotence) have become better appreciated.

Perhaps the most reliable study showing the potential benefit of PSA screening indicated about a 20 percent decrease in the risk of death from prostate cancer. But to save one life in the course of a decade, more than a thousand men would have to be screened. Even the most favorable study of PSA efficacy showed that all-cause mortality was not lowered by screening.

This suggests that while some men may have been spared dying from prostate cancer if screened, others died of other causes such that overall there was no difference in mortality. Another major study indicated no benefit with screening.

These disappointing findings led to a preliminary — and highly controversial —recommendation that argued against routine prostate cancer screenings in healthy men. We are left in a quandary. The best answer I can give you about PSA screening is “probably not,” but be sure to discuss this with your doctor if you (or your health care provider) don’t agree with the recommendation.

Q. What is aortic dissection? Can this cause other complications? A relative of mine suffered a Type B dissection and is now paraplegic.

A. The aorta is the main blood vessel that carries blood from the heart to the body. It branches into many tributaries that reach all of the organs. A dissection is a tear in the wall of the aorta and the biggest fear with a dissection is that the tear will extend all the way through the wall of the aorta, resulting in aortic rupture and massive bleeding.

Other problems that may result from dissection include disruption of the aortic valve (which is the one-way valve between the heart and the aorta), bleeding into the sac that surrounds the heart, or compression of any of the side-branches of the aorta. This is likely what caused your relative’s problems because the blood supply to the spinal cord comes from arteries coming off the aorta.

If one or more of them were compromised, the blood supply to the spinal cord would be interrupted, often with devastating results. Treatment of aortic dissection depends on where the tear is located.

Tears near the heart (so-called Type A dissections) invariably require surgery, or the outcome is usually fatal. Tears farther from the heart (Type B dissections, like in your relative) are treated with either medicine or surgery.

High blood pressure often predates a dissection, so good blood pressure control is paramount in all patients who have experienced an aortic dissection.

Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.

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The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.

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