Should I get a PSA test for prostate cancer?

A new study shows that screening for prostate cancer doesn’t necessarily save lives

Prostate cancer screening is about to get a whole lot cloudier.

Published this morning in the NEJM, the results of the study by the National Cancer Institute showed that, for men who were screened with both a PSA and digital rectal exam, there was no difference when compared to men who received “usual care.”

The results confirm the suspicions that many physicians already had, namely, that screening for prostate cancer does not appear to save lives.

As I have written countless times, there are many other diseases that can raise a PSA level. Combined with the fact that physicians have to act on elevated levels, this can lead to excessive prostate biopsies, as well as treating early cancers that end up not being the ultimate cause of death. All of these procedures expose the patient to a host of side effects, including bleeding and infection from the biopsy, and impotence and urinary incontinence from prostate cancer treatment.

The study was paired with the findings from a concurrent European study, which was not quite as negative. Nonetheless, the benefit of prostate cancer screening was minimal, with “7 fewer prostate cancer deaths for every 10,000 men screened and followed for nine years.”

Already, the USPSTF is shying away from endorsing prostate cancer screening by updating their guidelines last year, no longer recommending a PSA test for men older than 75.

So, what to do if you’re a patient? I think it’s more imperative than ever not to accept the dogma that “more screening is better medicine.” If anything, the decision of obtaining a PSA test needs to be thoroughly discussed with your doctor. Suddenly, the benefits of going down the path of screening doesn’t necessarily outweigh the risks.

Many may find that counterintuitive, and to be honest, it’s a hard truth to swallow. But these findings can help counter the pervading myth that obtaining every conceivable screening test is a sure way to improve health, when in actuality, it isn’t.

Routine Prostate Cancer Screening With PSA Test

Two papers published on bmj.com today report that there is unsatisfactory evidence to support population-wide screening for prostate cancer using the prostate specific antigen (PSA) test.

The PSA test cannot differentiate lethal from harmless prostate cancer, according to the authors. This could lead to over diagnosis and overtreatment of healthy men.

Prostate specific antigen (PSA) is a protein formed in the cells of the prostate gland. It is present in small quantities in the blood of healthy men. It is frequently elevated in men with prostate cancer and in men with benign prostatic enlargement.

Although it remains controversial, PSA screening is commonly used in many countries. The latest study suggests that prostate cancer deaths were lower among screened men but at a cost of significant over diagnosis and treatment.

A Swedish team of researchers set out in the first study to evaluate how well prostate specific antigen predicted a potential prostate cancer diagnosis.

They used PSA test results from 540 men diagnosed with prostate cancer measured several years before diagnosis and from 1,034 healthy controls. Results indicated that the PSA test did not reach the probability ratios. It is a measure used to predict disease required for a screening test. Only very low concentrations of PSA (less than 1ng/ml) virtually ruled out a diagnosis of prostate cancer during monitoring.

The researchers inform that there is a need for other biomarkers for early detection of prostate cancer and before population based screening for prostate cancer should be introduced.

US researchers looked at the benefits and risks of PSA screening in a second analysis paper. They concluded that data on costs and benefits remain insufficient to support population based screening. In addition, they recommend further accurate measuring of the financial and psychological costs of false positive results, over diagnosis and overtreatment of prostate cancer.

In conclusion, they consider that men should be entirely informed of the benefits, harms and uncertainties associated with the PSA test before they are screened.

This observation is supported in a complementary editorial by researchers at Monash University in Australia.

Dr Dragan Ilic and Professor Sally Green write: "Clinicians and patients are faced with many uncertainties when considering whether or not to undergo prostate screening."

They remark: "Further research is required to develop and evaluate a valid screening test for prostate cancer." Until such a test exists, the choice to undertake screening should follow a shared decision making approach