Jewish Men in Middle of PSA Controversy

Are the Risks of Prostate Screening Worth the Rewards?

Doubly at Risk: Rabbi Jon Adland, with wife Sandy in Pittsburgh, has two BRCA mutations.
Courtesy jon adland
Doubly at Risk: Rabbi Jon Adland, with wife Sandy in Pittsburgh, has two BRCA mutations.

By Talia Bloch

Published August 13, 2012, issue of August 17, 2012.
  • Print
  • Share Share
  • Single Page

(page 2 of 2)

“Many of the points brought up by the Task Force regarding the PSA test — such as that it was used for men who would not benefit from screening or that lower and lower levels of PSA led to biopsies — were valid,” said Dr. James Eastham, a prostate cancer surgeon who is chief of urology at Memorial Sloan-Kettering Cancer Center in New York. “But their conclusion that no one should get screened, we don’t agree with.”

Most vehement among the critics, perhaps, was the American Urological Association, which issued a swift and strongly worded response expressing “outrage” at the new guidelines and stating that: “It is inappropriate and irresponsible to issue a blanket statement against PSA testing, particularly for at-risk populations.”

Those known to be at higher risk from prostate cancer include African-American men, men with a history of prostate cancer in their families and those who carry BRCA mutations. Men in these groups are more likely to develop the disease and, more importantly, either die from it or experience symptoms.

Researchers have found that men with BRCA mutations are more likely to develop prostate cancer at a younger age. Men with a mutation on the BRCA2 gene, in particular, are more likely to develop a more aggressive form of the disease. The rate of BRCA mutations among Ashkenazi Jews is one in 40, compared with a rate of one in 500 in the general population.

“The Task Force did not specifically look at men with BRCA mutations,” said LeFevre, who added, “Unfortunately, the trials did not have enough high-risk men to allow us an informed decision about those groups.”

But many experts are concerned that such caveats are buried in the guidelines, and patients and primary care physicians, for whom the guidelines are intended, will get only the general message to simply stop PSA screening on all men.

“There are groups out there who are saying we are over-screening and over-treating, and that may be partly true, but we need to know who is at highest risk of developing and dying from prostate cancer.If you make a blanket statement, then you may be missing people who are at greater risk,” said Sue Friedman, president of FORCE, a national advocacy group for individuals with hereditary breast and ovarian cancers that provides support and information for individuals with BRCA mutations.

“We need to move away from a one-size-fits-all system of screening and prevention.”

Preliminary findings from IMPACT, an international study examining the benefit of prostate cancer screening tests for men who are carriers of a BRCA mutation, have so far shown the PSA test to be promising in detecting cancer early in this group. “Until the day when we can do more personal evaluation, PSA is still valuable for this high-risk population,” said Jacquelyn Powers, a cancer genetic counselor at the University of Pennsylvania’s Abramson Cancer Center and part of the IMPACT study.

Furthermore, among the approximately 1,200 men it has studied since 2005, IMPACT found identifiable prostate cancer in about half the men who had elevated PSA levels, tested positive for a BRCA2 mutation and elected to have a biopsy. Although the total numbers were quite small when compared with the control group, there was also a greater incidence of more aggressive prostate cancers within this group.

“We want to be diagnosing cancers in this group early, because we want to be treating them,” said Powers, who added that the IMPACT survey should be completed sometime between 2016 and 2018.

“We have to use PSA intelligently,” said Dr. James Mohler, chair of urology at Roswell Park Cancer Institute in Buffalo and chair of the National Comprehensive Cancer Network (NCCN) Guidelines Panel for Prostate Cancer. “We need to perform these tests in men who are at increased risk of developing a prostate cancer, who, if they develop that prostate cancer, are likely to die of it and for whom we can prevent that death by treating them.”

The NCCN, a consortium of 21 of the world’s leading cancer centers, has published its own guidelines for PSA testing, as has the American Urological Association and Memorial Sloan-Kettering. The NCCN recommends that all men get a baseline PSA test at age 40. The results, as well as a man’s general health, would determine the frequency of testing. For men at higher risk, such as from a BRCA mutation, Mohler said he would start testing early, at age 30.

Echoing most health care professionals, Mohler said that, ultimately, decisions about PSA testing are personal ones, to be made by a man in consultation with his physician. “I tell men they should religiously follow their guideline of choice,” said Mohler, “A guideline is a guideline and not a rule. Every person thinks of their mortality and morbidity differently.”

For Adland, already being watched for his BRCA risk, the new guidelines are not likely to change his care. “I’m the guy who leaves things up to his doctor; as long as he understands it, I’m fine.”

Talia Bloch writes on culture, religion, and science. Contact her at feedback@forward.com


The Jewish Daily Forward welcomes reader comments in order to promote thoughtful discussion on issues of importance to the Jewish community. In the interest of maintaining a civil forum, The Jewish Daily Forwardrequires that all commenters be appropriately respectful toward our writers, other commenters and the subjects of the articles. Vigorous debate and reasoned critique are welcome; name-calling and personal invective are not. While we generally do not seek to edit or actively moderate comments, our spam filter prevents most links and certain key words from being posted and The Jewish Daily Forward reserves the right to remove comments for any reason.





Find us on Facebook!
  • "Everybody is proud of the resistance. No matter how many people, including myself, disapprove of or even hate Hamas and its ideology, every single person in Gaza is proud of the resistance." Part 2 of Walid Abuzaid's on-the-ground account of life in #Gaza:
  • After years in storage, Toronto’s iconic red-and-white "Sam the Record Man" sign, complete with spinning discs, will return to public view near its original downtown perch. The sign came to symbolize one of Canada’s most storied and successful Jewish family businesses.
  • Is $4,000 too much to ask for a non-member to be buried in a synagogue cemetery?
  • "Let’s not fall into the simplistic us/them dichotomy of 'we were just minding our business when they started firing rockets at us.' We were not just minding our business. We were building settlements, manning checkpoints, and filling jails." What do you think?
  • PHOTOS: 10,000 Israel supporters gathered for a solidarity rally near the United Nations in New York yesterday.
  • Step into the Iron Dome with Tuvia Tenenbom.
  • What do you think of Wonder Woman's new look?
  • "She said that Ruven Barkan, a Conservative rabbi, came into her classroom, closed the door and turned out the lights. He asked the class of fourth graders to lie on the floor and relax their bodies. Then, he asked them to pray for abused children." Read Paul Berger's compelling story about a #Savannah community in turmoil:
  • “Everything around me turns orange, then a second of silence, then a bomb goes off!" First installment of Walid Abuzaid’s account of the war in #Gaza:
  • Is boredom un-Jewish?
  • Let's face it: there's really only one Katz's Delicatessen.
  • "Dear Diaspora Jews, I’m sorry to break it to you, but you can’t have it both ways. You can’t insist that every Jew is intrinsically part of the Israeli state and that Jews are also intrinsically separate from, and therefore not responsible for, the actions of the Israeli state." Do you agree?
  • Are Michelangelo's paintings anti-Semitic? Meet the Jews of the Sistine Chapel: http://jd.fo/i4UDl
  • What does the Israel-Hamas war look like through Haredi eyes?
  • from-cache

Would you like to receive updates about new stories?




















We will not share your e-mail address or other personal information.

Already subscribed? Manage your subscription.