PSA Testing May be More than a Pain in the Ass

Written by: Dr. Jeffrey Barke

PSA testing has been the standard testing mechanism for the detection of prostate cancer for many years. It stands for prostate specific antigen and is a simple blood test that has been relied upon by primary care and specialty physicians alike. However, this standard test is under attack and rightfully so.

The U.S. Preventive Services Task Force (USPSTF) has recently published a draft recommendation AGAINST prostate specific antigen or PSA screening for prostate cancer in asymptomatic men. The USPSTF gave PSA screening in asymptomatic men a D recommendation, which means there is a moderate or high certainty that the test has no net benefit or that the harms outweigh the benefits. The benefit, of course, would be detecting prostate cancer early. The harm is that the vast majority of those diagnosed with prostate cancer will never be harmed by this mostly very slow growing cancer; you get the risks associated with treatment but no benefit.

According to Dr. LeFevre, a professor at the University of Missouri, Columbia, for every 1,000 men treated for prostate cancer, five die of complications from the prostate surgery; 10-70 suffer significant complications but survive; and 200-300 suffer long-term problems including urinary incontinence (think lifelong Depends), impotence (inability to get an erection) or both.

USPSTF noted that the majority of men who have asymptomatic cancer detected by PSA screening have cancer that either will not progress or is so slow-growing that it will not affect the men’s life spans.

So what to do? The USPSTF, although well respected, is but one authority that makes recommendations. The American Urological Association continues to support the use of the PSA test. At minimum you should have a conversation with your doctor about the USPSTF recommendation and how that applies to you. Family history, age and current symptoms all play a role in determining whether to screen or not. The art of medicine is in part, knowing how to apply the latest research and data to an individual patient.