Nothing has created more controversy in the past few years than screening for prostate cancer using the PSA blood test. The PSA blood test has been available for more than 30 years and has discovered more prostate cancers, approximately 250,000 new cases a year in the United States. However, there are reasons that the PSA test is not a perfect test. For example, the PSA can be elevated in men with large, benign prostate glands which is very common in older men as the prostate gland increases in size after age 50. Also men with prostate gland infections will have an elevation of their PSA levels. As a result, men with an elevated PSA level may submit to a prostate biopsy which has risks of infection, bleeding, and discomfort during the procedure.
PSA testing for the new millennium
The PSA test was used for many years without any clear evidence for or against it, and without the US Preventive Services Task Force (USPSTF) providing a specific recommendation. In 2009 the USPSTF recommend against PSA screening based on two studies, one from the U.S. and the other from Europe.
Now new evidence has shown that men in both trials who underwent screening as recommended had lower rates of death due to prostate cancer. As a result, the USPSTF proposed changing its recommendations to say that health care providers should now discuss the pros and cons of the test using a process called shared decision making.
PSA Testing Using Shared Decision Between Doctor and Patient
Though this new study may explain why these two trial results differed, I don’t expect the USPSTF will change its recommendation. I am a believer of the shared decision making approach to PSA testing with my patients. Decades of using the test have also uncovered real harms such as men diagnosed and treated for prostate cancers that otherwise never would have been detected or caused harm.
Bottom Line: For those who elect to have the test, we need to do a better job figuring out who needs treatment when prostate cancer is found, and how to make sure we avoid harming those without such disease — harm that can be both psychologic in terms of worry and physical in terms of side effects from treatment.