Tests for Prostate Cancer: Effective or Not?

Although prostate cancer is the second leading cause of cancer death in men (lung cancer being number one) it's not clear if the benefits of screening outweigh the risks of treating what is generally a slow-growing and treatable (in the early stages) cancer.

According to the American Cancer Society, there were 217,730 new cases of prostate cancer in 2010, resulting in 32,050 deaths. The prostate--located below the bladder and in front of the rectum--contains cells that make some of the fluid in semen. Prostate-specific antigen (PSA) is an enzyme that keeps the semen in liquid form. In younger men, the prostate gland is about the size of a walnut. However, enlargement can be a normal consequence of aging.

There are two tests to detect prostate cancer-a Digital Rectal Exam (DRE) and a PSA blood test. When performing a DRE, the doctor feels for prostate-gland irregularities through the rectum. PSA levels are analyzed by taking a blood sample. A normal PSA level is less than four nanograms per milliliter (ng/mL); a PSA above ten indicates a high risk of cancer. But there are many exceptions, also called false positives. A high PSA reading could be an indication of some other kind of prostate condition such as enlargement (also known as BPH, benign prostatic hyperplasia) or inflammation (prostatitis).

If detected early, prostate cancer is treatable but recommendations for screening vary due to what some medical experts consider limitations of the PSA screening test.

Medicare currently provides coverage for an annual PSA test for all men age 50 and older. The American Urological Association (AUA) recommends a first-time PSA blood test at age 40. Without question, the PSA test helps spot prostate cancer early on but it doesn't tell a doctor if the cancer is dangerous. Only a biopsy can predict an aggressive form of prostate cancer.

Most prostate cancers are slow-growing and may exist for decades before they cause symptoms, which include a weak or interrupted urinary stream; blood in the urine, and impotence. Subsequent PSA tests may indicate a problem before the disease progresses significantly. According to the American Cancer Society, only 25 to 35 percent of men who have a biopsy due to an elevated PSA level actually have prostate cancer-but most do not.

Unnecessary biopsies, undue financial burden, and patient anxiety are among the reasons that compelled researchers from Memorial Sloan-Kettering Cancer Center in New York City to look at data on 5,519 males from the Prostate Cancer Prevention Trial. The patients were all aged 55 years or older and had no previous prostate cancer diagnosis. In addition, all had normal digital rectal exams and a baseline PSA of no more than 3.0 ng/mL. Some of the men were selected to take finasteride, a medication used for patients with BPH, or a placebo for a seven-year period.

After adjusting for age, race (African-American men are prone to prostate cancer) and PSA levels, the scientists found no significant link between rapidly rising PSA levels and biopsy outcomes. It was not the rate of rise that predicted cancer likelihood, but rather the actual PSA level itself. So, a man with a steady PSA level of 5ng/mL was more likely to have prostate cancer than one whose level rose from 2.5 to 3.4ng/mL.

Researchers concluded that PSA velocity (levels that rise rapidly) is a poor predictor of prostate cancer and often leads to unnecessary procedures and worry. According to the Journal of the National Cancer Institute, researchers stated that men should not have a biopsy if their clinical exam is normal.

The UAU guidelines advise a surgical biopsy for men found to have a high PSA velocity even if the doctor finds no other indicators pointing to cancer.

As the debate continues regarding who should get treatment and who should be closely monitored but not treated, studies are ongoing to determine if early tests for prostate cancer in large groups of men will lower the prostate cancer death rate and help men live longer. Until there is more clarity, experts generally agree that it's best to make an informed decision about the potential risks and benefits of PSA screening before being tested.

Sources:

National Cancer Institute
http://www.cancer.gov

National Institutes of Health
http://www.NIH.gov

American Urological Association Foundation
http://www.Urologyhealth.org

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Generic Skincare Products: As Effective As the Big Brands?

If your budget doesn't extend to $100 or more for skincare, you've probably tried or considered generic alternatives. These over-the-counter and prescription formulas claim to be identical to their big-name siblings and often come in identical packaging. But will they yield the same results?

Any generic prescription drug—skincare or otherwise—has undergone extensive FDA (Food & Drug Administration) testing to ensure that it is the equivalent of the brand-name product. Additionally, the manufacturing techniques, labeling practices, and production regulation have to meet the same standards as the original product. These identical quality standards mean that you should experience the same results from a generic brand as you would from the brand-name formula. The only drawback is that the newest formulas may not have a generic equivalent, since when drugs are first released, they are typically patent-protected and generic formulas can't be offered until that patent expires.

However, over-the-counter products are different. They are not regulated or tested the same way, since the FDA considers over-the-counter skincare products to be cosmetics. To the FDA, over-the-counter formulas are low-risk, hard to abuse, and don't need a doctor's expertise to administer. The FDA is, however, heavily involved in regulating the way that these products are labeled. Over-the-counter products have certain standards to ensure the ingredients, warnings, and instructions are clearly spelled out on the label. These standards apply to both brand name and generic products.

Because of the lessened regulation, consumers have to perform the research and comparison between brand name and generic skincare products. Don't be fooled by the packaging or shelf placement; the key is reading the two labels. First, take a look at the ingredient list for each product. Are the percentages of the active ingredients the same? If no percentages are listed, are they listed in the same order? Generic brands may skimp on the concentration of the key ingredients, or leave out some of the soothing ingredients that can help reduce skin irritation, especially if you have sensitive skin. Stronger formulas, especially in the case of acne medication, can be rough on skin, so you may want to consult a dermatologist to help steer you in the right direction.

The overall quality of over-the-counter generic skincare is getting better and better. The risk of it not working is going to put a much smaller dent in your wallet than the original formula. And if you are choosing a generic, you know that the original was effective enough to last in the competitive marketplace, so it's probably well worth a try.

Sources:

Fda.gov: "Regulation of Non-Prescription Drug Products." U.S. Food and Drug Administration. Web. January 5, 2011. http://www.fda.gov/downloads/AboutFDA/CentersOffices/CDER/UCM148055.pdf

Health.uab.edu: "Generic Drugs." UAB Health System. Web. 2008. http://www.health.uab.edu/17716/

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