PSA Test for Prostate Cancer: To Screen or Not to Screen

The unanswered question is, do the benefits of testing outweigh the risks of follow up diagnostic procedures and prostate cancer treatment?

The PSA tests measures the level of Prostate-Specific Antigen in a man's body. An elevated PSA may indicate prostate cancer, but other conditions also increase PSA levels. Physicians must take a tissue sample (biopsy) to diagnose prostate cancer definitely. Biopsies can cause side effects, including infection and bleeding, and prostate cancer treatment raises the risk of incontinence and erectile dysfunction.

PSA tests are not precise. Only 25 to 35 percent of men who have biopsies following elevated PSA test actually have prostate cancer. Although PSA tests help indentify prostate cancer, there's no evidence it necessarily reduces men's chance of dying from prostate cancer.

Study Results

Two recent studies report conflicting results. In the U.S., a long-term study lead by the National Cancer Institute concluded that PSA tests did not reduce the number of deaths from prostate cancer through 11.5 years of follow up. Men screened for prostate cancer died, while those who weren't lived longer and better. Researchers will continue to follow study participants.

In a European Union study, scientists reported PSA screening reduced prostate cancer deaths by 20 percent. Participants had a PSA test every four years. Researchers estimate that physicians must screen 1,410 men and detect 48 additional cancers to prevent one death from prostate cancer.


There are different perspectives on this controversy.

Advocates of PSA testing believe that absent specific screening recommendations, it's reasonable to over-detect rather than under-detect. They believe routine screening recommendations prompts providers to offer the PSA test uniformly to all patients.

In April 2009, the American Urological Association lowered the age for PSA screening (in conjunction with digital rectal exams) to 40 in healthy men who want to be tested. At the same time, it acknowledged the risk of over-detection and over-treatment.

Skeptics of the PSA test argue that diseases vary in seriousness. Prostate cancer that causes no symptoms (asymptomatic) may never lead to illness or death so treatment is not necessary. Approximately 25 percent of men between 50 and 75 have asymptomatic prostate cancer.

The U.S. Preventive Services Task force, a leading panel of prevention experts, concludes there's insufficient evidence to recommend for or against preventive screening and believe patients deserve to have this information.

The bottom line? Prostate cancer screening is a personal decision for a man to make in consultation with his physician and urologist.