PSA Test: Reconsidering the Recommendation

The prostate cancer screening test called PSA, which checks levels of the protein prostate-specific antigen, has a history checkered with controversy. The test can save lives, yet it has been long-known not to be perfect. For starters, there are an uncomfortable number of screening tests that turn out to be false positives, which leads to many men having unnecessary biopsies.

However, since the PSA test was one of the few tools to diagnose prostate cancer, many doctors continued to recommend the test and many patients continued to request the test. The desire for an early diagnosis is understandable since prostate cancer remains the second most common cancer in American men, following skin cancer, with one in every seven men being diagnosed at some point in his life.

After reviewing the pros and cons surrounding the PSA test, the U.S. Preventive Services Task Force recently issued new recommendations about prostate cancer. These new recommendations are currently in draft form. After concluding that prostate cancer screening only results in a small overall benefit, this organization now recommends cautious use of the PSA screening, specifically:

  • No routine testing for men age 55-69. However, patients should be informed about the potential harms and benefits so individual decisions can be made. For this age group there is only a small potential benefit of reducing cancer mortality, yet there are adverse effects from additional testing in men who ultimately are not found to have prostate cancer.
  • No testing for men over the age of 70. For this age group, the task force does not recommend the PSA at all. Prostate cancers tend to be slow growing, thus in this age group, even if prostate cancer is present, it is unlikely to be fatal.

Researchers in the New England Journal of Medicine point out that one death from prostate cancer could be avoided for every 1,000 men who are regularly screened with a PSA test (and their health is tracked for 10-15 years). However, for each group of 1,000 men who are screened, there will be 35 men who are over-diagnosed (meaning they receive unnecessary and invasive procedures yet ultimately do not have prostate cancer).

Considering the controversies that continue to swirl around the PSA test, this is unlikely to be the final or unchallenged recommendation for men regarding prostate cancer.

Source

Pinsky PF, Prorok PC, Kramer BS. Prostate cancer screening: A perspective on the current state of the evidence. New Engl J Med 2017;376:1285-9.

USPSTF issues draft recommendation statement on prostate cancer screening. Univadis April 13, 2017.

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