- - Tuesday, April 18, 2017

ANALYSIS/OPINION:

I need a full arsenal of medical screening tools at my disposal to help my patients. Some of the tools I have are new, and others have been around a long time. They help me assess the risk of getting a disease, or in the case of a colonoscopy or a cardiac stress test, of already having one.

This is why I opposed the U.S. Preventive Services Task Force (USPSTF) recommendation (since 2012) that men not have the Prostate Specific Antigen test. It is also why the new USPSTF recommendation issued last week that men discuss the risks and benefits of the PSA test and then decide whether or not to have it is still not good enough.

Every male over the age of 45 should have their PSA tested.

Prostate Specific Antigen is a useful test that has come under unjustified attacks not because of the test itself but because of the doctors who overreact to it. Close to 30,000 men still die of prostate cancer every year and the PSA is still the best way I have to know there is something wrong with the prostate. I check it in every male over 45 just as I check your cholesterol level. Research tells me that a high cholesterol puts patients at risk of heart disease and stroke. Whether I treat a high cholesterol with medication or not has to do with many factors, including family history of heart disease, weight, age, lifestyle, as well willingness to take the medicine.

Like cholesterol level, PSA does not tell me about a specific disease (in this case, cancer) but whether the patient has a medical problem I need to address. I use PSA as a guide and I follow a trend much as I follow a cholesterol trend. I am also interested in your family history of prostate cancer. I realize that PSA may be elevated from an infection or an enlarged prostate rather than cancer and I factor that in, too, before I rush to order a biopsy. I combine the information the PSA gives me with the way a prostate feels when I examine it. Is there a nodule? Do I need to do something?

Over the past month alone I saw one 60-year-old patient with a high PSA of 7, which hadn’t changed much in years and so I followed it. He had one biopsy, which was negative. Another 50-year-old patient had a sudden spike in his PSA from 2 to 5, but in turned out he had an infection and his PSA returned to normal after receiving an antibiotic. A third 67-year-old patient with a rising PSA turned out to have prostate cancer and elected to have his prostate removed because the cancer appeared to be growing rapidly and had reached the outer portion of his prostate.

The common denominator in all three cases was a discerning doctor to interpret results and help guide the patient.

Now we are entering an exciting, new era of personalized medicine, when we will be able to assess the risk of a disease before the patient actually get it. In fact, new genetic testing is already becoming widely available. With 23andMe, the FDA has just approved an over-the-counter genetic test, which predicts with 99 percent certainty whether you are at risk for 10 important diseases, including Alzheimer’s, Parkinson’s, Celiac, clotting and iron overload disease. It sounds great, but what is missing is the doctor to tell you what to do with these results. The accuracy is sufficient but the rudderless process of obtaining it isn’t.

Instead of worrying what these results mean — a normal reaction if your test isn’t normal — it would be much better if I accumulated a patient’s genetic risk data in the first place and then helped him interpret and respond to it.

• Marc Siegel, a physician, is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News medical correspondent.

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