Published on March 9, 2020
It’s a widely accepted notion: Early detection of cancer leads to a longer and healthier life.
But there is a lot of debate over the value of prostate-specific antigen, or PSA, screening. That’s partly because prostate cancer is slow-growing—it can take years to become large enough to be detectable—and the side effects from surgery and other treatments (which may not be necessary) can be significant.
The years-long controversy over the risks and benefits of the PSA test was the focus of a recent New York Times column by Jane Brody. In it, Brody highlights what she notes are the limited advantages of PSA screening.
“In many men identified as having prostate cancer following PSA screening, the disease is neither aggressive nor likely to kill them before something else does,” she writes. “In fact, a previously unknown prostate cancer is found at autopsy in more than a third of men who die in their 70s or older from some other cause.
“Yet when a biopsy after an elevated PSA reveals cancer, even a cancer considered indolent, it can provoke considerable anxiety, and some men may choose to undergo unnecessary treatment that can cause impotence, incontinence or both.”
The FDA approved the PSA blood test as a screening tool in 1994. Since then, the number of men diagnosed with prostate cancer has grown exponentially, and the death rate has dropped by more than half.
However, in 2012, the United States Preventive Services Task Force (USPSTF) found little evidence that the test saved men’s lives and recommended against PSA screening
Facing a backlash from urologists and prostate cancer patients, in 2018, the USPSTF issued new recommendations that for men ages 55 to 69, prostate cancer screening should be up to the individual, and each man should discuss the potential benefits and harms of screening with his doctor. The USPSTF recommended against routine PSA testing for men 70 and older.
Brody explains there are “possible exceptions that could tip the scale in favor of screening.”
She says there is a potential benefit for younger men with a strong family history of prostate or related cancers and African American men, who are more likely than others to develop an aggressive prostate cancer. For them, screening is best started at age 40 or 45, she says.
The good news is that new and better screening tests are on the horizon. The 4Kscore Test, which uses four prostate-specific biomarkers and your clinical information, and the Prostate Health Index, (PHI), which uses a combination of three blood tests, may be more accurate and effective in detecting aggressive prostate cancer.
But until then, be sure to talk to your doctor about whether PSA screening is right for you and if you should undergo treatment if prostate cancer is diagnosed.
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