Prostate cancer screening: the ongoing debate
Since its adoption by the FDA in 1994, the prostate-specific antigen (PSA) test has reduced prostate cancer mortality rates by 39 percent. Despite the lives saved, whether or how the PSA test should be used for screening is at the center of an ongoing debate.
In 2012, the U.S. Preventative Services Task Force (USPSTF) recommended against the use of PSA-based screening after new studies showed that the test led to overdiagnosis and overtreatment. In 2013, the American Urological Association changed its guidelines to recommend against screening for men under the age of 55 who are at average risk of prostate cancer and for men over the age of 70 who have a life expectancy of less than 10 to 15 years. The American Cancer Society recommends that men make an informed decision with their health care provider about prostate cancer screening; it does not take a stance for or against PSA testing. The National Cancer Institute makes no formal recommendation, but presents information on its website helpful for decision making.
Is the PSA test right for you? The answer to this question varies person to person, so I recommend that you talk to your doctor about your individual risk and educate yourself about the pros and cons of testing.
Here are a few important questions to ask your doctor:
What is my risk of developing prostate cancer?
Common risk factors include: age, race/ethnicity, nationality, family history of prostate cancer, genetics, diet and smoking.
Is PSA testing appropriate for me and if so, when should I begin testing?
Your doctor may or may not recommend testing, but if you are at high risk, he/she may advise testing at a younger age.
What is the purpose of a PSA test and how is it done?
A PSA test measures the level of PSA, a protein that is produced by the prostate gland, in a man’s blood. The higher your PSA level, the more likely it is that you have prostate cancer. The test requires a blood sample that is sent to a laboratory for analysis.
What are common side effects or risks of PSA testing?
The PSA test itself doesn’t have side effects, but overdiagnosis and overtreatment are the risks that have caused the screening debate. Some tumors found through PSA testing grow so slowly that they are unlikely to threaten a man’s life. Detecting non-life-threatening tumors is called overdiagnosis, and treating those tumors is called overtreatment. Overdiagnosis and eventual overtreatment, with procedures such as biopsies, radiation and hormone therapy, can lead to unnecessary complications such as urinary incontinence, problems with bowel function, erectile dysfunction and infection. Also, one of the greatest “risks” for patients who have a high PSA test is their tendency to panic after they hear the word “cancer” and to seek aggressive treatment whether or not it’s warranted, so it is important to thoroughly consider all of your options before taking action.
As with any test, there are both benefits and harms of prostate cancer screening. An important benefit of testing includes catching the cancer before it metastasizes (grows) or becomes life-threatening.
By identifying the cancer early, less-aggressive treatment is needed and outcomes are generally better. By discussing the test with your doctor, you will know more about your options and will be less likely to make hasty decisions out of fear. I also recommend receiving a second opinion from another physician before making any decisions about treatment.
About the author
Paul G. Goetowski, M.D. (known as “Dr. G.”), is assistant professor at VCU Massey Cancer Center and the director of radiation oncology at Community Memorial Healthcenter (CMH) Cancer and Specialty Care on behalf of Massey. He has extensive experience in using radiation to treat many cancer types and noncancerous diseases.