Darren Line was only 44 when his urologist told him his PSA score had abruptly doubled. The new score was “normal,” but he and the doctor suspected trouble.
The men in Line’s family had a history of prostate cancer so Line began getting a prostate-specific antigen (PSA) test at 35. PSA is a protein released naturally by the prostate, easily identified and analyzed through a simple blood test. Line insisted on a fresh test every year.
He was glad later for his vigilance. As he feared, the sudden change in the PSA score led to a diagnosis showing he, too, had been hit with the family curse.
“If I hadn’t gotten tested, I’d be dead — it’s that simple,” said Line, a family dentist at St. Margaret’s Hospital in Spring Valley, where he enjoys surgical privileges.
Line underwent successful surgery and emerged with no complications whatsoever. He openly discusses his cancer diagnosis and treatment with anyone who asks and has a message for any man inching into middle age: Get a yearly PSA test.
“I think there’s value to it, and I’m not a specialist, but I do know that it saved my life,” Line said. “I’ve been practicing in Spring Valley for 15 years and I’m looking forward to serving the Illinois Valley another 15 years.”
Until recently, the medical community would have agreed with Line and urged all men over 50 — and for those with a family history, over 40 — to get a yearly PSA test, available for as little as $20. Coupled with a digital-rectal exam, regular PSA tests enable physicians to catch prostate cancer at early and treatable stages.
But over the past two years, medical researchers have begun to change their tune. The American Urological Association issued a startling study in April suggesting that just 1 in 1,000 lives are saved through the PSA. The upshot of the study is a recommendation that men still undergo a yearly prostate exam — but the exam, the association now says, may or may not have to include the simple blood test.
Christian Schwartz, a urologist in Peru and Spring Valley, doesn’t dispute the data — the numbers are what the numbers are — but he has concerns with some of association’s conclusions and recommendations.
“There’s been a release of data suggesting that regular PSA testing does not save lives,” he said. “This is hugely different from the training I went through and from the practice pattern that we established over the past decade.
“And I don’t like blanket statements that PSA testing doesn’t save lives,” he said. “PSA testing definitively saves lives.”
Schwartz, Line and other prostate cancer survivors are advising area men to not misread the study and assume that a PSA test isn’t a healthy and life-saving practice. The American Urological Association has in no way disregarded or discredited the PSA test, only questioned the percentage of lives saved, and is not, in any way, telling men not to see the doctor.
“My gut reaction is that when men are told they no longer need a test it’s easier for them to say, ‘Oh, that’s great: I don’t have to go to the doctor,” Schwartz said. “But, really, the recommendations are about PSA testing and when they should be done. It still is underlying, in the recommendations, that men should stay have a yearly prostate exam. So it doesn’t really lessen the testing, it lessens the blood work.”
The notion that the PSA has saved “only” 1 in 1,000 lives doesn’t sit well with area men who owe their lives to the PSA test.
Jim Narczewski, former Spring Valley mayor, said he’s a “big believer” in the PSA test after his surprise cancer diagnosis in 1996.
Narczewski had undergone an invasive test at age 49 that showed no sign of cancer whatsoever. Two years later, however, Dr. Louis Lukancic Sr. conducted a digital test suggesting something amiss and then demanded a PSA test. Lukancic was so insistent he even stood in the doorway to keep Narczewski from bolting without the blood draw.
Lukancic saved Narczewski’s life.
“At 49, I was clear; at 51, I had cancer,” Narczewski recalled. “In my case, if I’d waited another six months, I’d have been in real trouble.”
Narczewski was stunned not only with the appearance of cancer after seemingly recent clean bill of health but how quickly it seemed to grow. The first PSA test came in at 13; a few weeks later Narczewski tested again and learned the PSA had shot past 18.
When told physicians have abandoned their insistence on yearly PSA tests, Narczewski shook his head. For him, periodic testing might have been a death sentence.
“I think it is a mistake to say, ‘Wait every four years or five years,’” he said, “Because if I had waited that long, I wouldn’t be sitting her now. It’s just a fact.”
Oglesby businessman and radio host Tim Moritz was rightly concerned with his PSA test results in January of 2010. As with Line, his latest screening showed a normal score, but one that had sharply increased from his previous test.
“And that’s what raised the red flag,” Moritz said. “People could have numbers that are higher than mine, but it all depends on what the baseline was.”
Significantly, the doctor saw no other signs that might indicate cancer. Yet within three months of the PSA test, Moritz was diagnosed with prostate cancer and had completed treatment.
“I was back at work in nine days and I was back to full aerobic activity in six weeks,” he recalled. “The PSA worked in my case, because I had no other symptoms in any way, shape or form. I would have had no other way to know.
“Just do it,” he counseled. “It’s a prick of a blood is all it is.”
Schwartz said Moritz’s story is common: Men regularly come in and get PSA bearing a high or abnormal score, but no clinical symptoms. Without the PSA, he said, many of these men would not have otherwise known they had cancer until the disease was too far gone to cure it.
When the association released its numbers, Schwartz said, the question raised shouldn’t have been whether to modify a proven indicator of prostate trouble but rather revisit the medical options once the PSA leads to diagnoses of varying severity.
“My feeling is we should continue with PSA testing and digital-rectal exams regularly,” Schwartz said, “but we should use our clinical judgment to determine if it’s significant disease that would warrant therapy, and that we should perform more observation of the disease — not ignore it and not test for it.”
Tom Collins can be reached at (815) 220-6930 or email@example.com.