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A series of blood tests led Peter Wilson down an unexpected path, but one that eventually saved his life. Over a period of 18 months, Wilson’s level of prostate-specific antigen, or PSA, had risen high enough to warrant a biopsy. The results came as a shock to this Boston College professor: a diagnosis of prostate cancer.
Fortunately, Wilson’s cancer was detected early, allowing him the luxury of successful treatment at BWH and a clean prognosis. Many men are not so lucky. Prostate cancer is the number-two killer among men in the U.S., with an estimated 30,000 deaths and 230,000 new cases each year, according to the American Cancer Society. Despite these facts, only about 60 percent of American men over 50 have had a PSA screening.
The PSA test is used to diagnose prostate cancer by measuring the level of prostate-specific antigen in the blood. The level can rise naturally as a man gets older and the prostate enlarges, or it can rise due to cancer. What physicians have been grappling with is what level actually predicts the presence of cancer. BWH researchers recently published a groundbreaking study in New England Journal of Medicine that suggests how PSA results should be interpreted.
The study found that men with prostate cancer whose PSA level increased significantly the year before they were diagnosed were more likely to have more aggressive cancer and to die within seven years. “This study shows fairly conclusively that it’s not the level of PSA that matters, it’s the change from year to year,” said Anthony D’Amico, MD, chief of BWH Genitourinary Radiation Oncology, and Wilson’s physician. The finding underscores the importance of getting regular PSA screenings, so that physicians can spot trends.
“Peter’s cancer was picked up because we had the benefit of watching his numbers over time,” said D’Amico. “He is the example of what we should do with every patient.”
D’Amico hopes this message will reach thousands of men across the country during September, which is Prostate Cancer Awareness Month. The current practice is to begin screening at age 50—or at age 45 for African-Americans and men with a family history of prostate cancer. D’Amico suggests men get a baseline PSA screening at age 35, and then annually at age 45. “The problem is, by the time many men receive their first screening, many of them already harbor prostate cancer cells at some level,” said D’Amico.
Wilson, who is grateful to D’Amico for his compassionate care, wants men to be spared the ordeal he had to bear. “Get a PSA test early on and begin to track it,” Wilson advised. “If you have prostate cancer and you’ve caught it early, then you have a good chance for survival.”