Why is the PSA test controversial in screening?

Using the PSA test to screen men for prostate cancer is controversial because it is not yet known for certain whether this test actually saves lives. Moreover, it is not clear that the benefits of PSA screening outweigh the risks of follow-up diagnostic tests and cancer treatments. For example, the PSA test may detect small cancers that would never become life threatening. This situation, called overdiagnosis, puts men at risk of complications from unnecessary treatment.

The procedure used to diagnose prostate cancer (prostate biopsy) may cause harmful side effects, including bleeding and infection. Prostate cancer treatments, such as surgery and radiation therapy, may cause incontinence (inability to control urine flow), erectile dysfunction (erections inadequate for intercourse), and other complications. For these reasons, it is important that the benefits and risks of diagnostic procedures and treatment be taken into account when considering whether to undertake prostate cancer screening.

What is the PSA test and who might have it done?

It is a blood test that measures the level of PSA in your blood. PSA stands for Prostate Specific Antigen. PSA is a protein made by the prostate which naturally leaks into the bloodstream.

Some men with symptoms of a prostate problem may consider having the test. The symptoms of benign prostate enlargement can be similar to the symptoms of a developing prostate cancer. Some men without any symptoms consider having the test to 'screen' for prostate cancer.

However, in both of these situations, the decision to have a PSA test is controversial as there are pros and cons.