Elderly Man at the Doctor's

Nothing sparks more controversy in the urologic world as the PSA test.  PSA is a blood test used in men to screen for prostate cancer.  The higher the PSA, the greater the probability of finding prostate cancer on biopsy.  The problem is that often we find small volume, less aggressive cancers that may not need to be treated.  This can lead to overtreatment, which has potential negative effects.  The data can be interpreted from different perspectives.

Some of the arguments against checking your PSA are:

  1. Studies have shown that almost 70% of men older than the age of 70 have some form of prostate cancer.
  2. Only a small percentage of men with prostate cancer die from the disease.
  3. There are risks to having a prostate biopsy.
  4. There is significant stress and loss in quality of life when a man is diagnosed with prostate cancer, even if it’s the low volume, less aggressive type.
  5. Short term studies have shown no benefit in screening for prostate cancer.
  6. The U.S. Preventive Service Task Force, a government appointed agency, recommends against prostate cancer screening.

Arguments in favor of checking PSA and screening for prostate cancer are:

  1. Prostate cancer is the number 2 cancer killer of men in America.
  2. Since we started checking PSA, the death rate from prostate cancer has dropped 47%.
  3. The death rate for men diagnosed with metastatic disease (it already spread outside of the prostate) has not changed during this same period. This indicates the improvement in death rate is from those with early diagnosis.
  4. Studies on PSA screening that have followed men longer than 10 years show a survival benefit for screening.

Common sense needs to be used in this situation.  Data and statistics can be manipulated to show almost anything you want.  The short term U.S. study is roughly the equivalent of taking 1000 twenty-year-old men and having half of them smoke for five years.  At the end of the study, the fact that no one had died of lung cancer or heart disease would then “show” us that tobacco doesn’t cause these problems. Does this mean it’s true? No, it means that the study was designed poorly. 

PSA is a tool – it needs to be understood and not abused.  Yes, PSA is overused and yes, prostate cancer is over-treated BUT these are problems we should learn from, not turn away from.  Most urologists recommend screening every 1-2 years from ages 50 to 69.  Men at higher risks or with symptoms can start earlier.  Those who are in great health and have a life expectancy greater than 10 years can continue to check.  This should be a shared decision between you and your doctor.  I’m sure there is a lot more to come!