In 1994, the Food and Drug Administration
approved the use of the prostate-specific antigen (PSA) test, used in conjunction with a
digital rectal exam (DRE) to screen asymptomatic men for prostate cancer. PSA is a protein produced by cells of the prostate gland.
The test measures the level of PSA in a man’s
blood, which is often elevated in men with
Men who report prostate symptoms might
undergo PSA testing along with a DRE to help
doctors determine the nature of the problem.
Does screening work?
In 2012, the U.S. Preventive Services Task
Force recommended against PSA-based
screening for men who do not have symptoms, citing “moderate or high certainty that
the service has no net benefit or that the
harms outweigh the benefits.” Their summary
says there is adequate evidence that the benefit of PSA screening and early treatment
ranges from zero to one prostate cancer death
avoided per 1,000 men screened.
Since that recommendation, professional
organizations have altered PSA screening
guidelines. Some, such as the Centers for
Disease Control and Prevention and other
federal agencies, recommend against PSA-
based screening for men without symptoms of
a prostate problem.
Other organizations, including the
American Cancer Society and the American
Urological Association, leave the decision to
the individual, who should come to a conclusion about screening based on personal values; discussions with doctors, family and
friends; and available information about the
risks and benefits of PSA screening.
What’s risky about a PSA blood test?
It’s the choices that come after the test
results that prove risky. The National Cancer
Institute describes the limitations and poten-
tial harms of PSA screening in their fact sheet
• When used in screening, the PSA test
can help detect small tumors that do not
cause symptoms. But finding a small tumor
may not necessarily reduce a man’s chance of
dying from prostate cancer.
• False positives are common. Only one
in four men with abnormal PSA results turn
out to have prostate cancer.
• Fast-growing prostate cancers may not
produce much PSA, and may yield a false negative result so the individual is told he doesn’t
have cancer when he actually does.
•Detecting tumors that are not life-threatening is called overdiagnosis, and treating these tumors is called overtreatment.
Overtreatment exposes men unnecessarily to
the potential complications and harmful side
effects of treatments for early prostate cancer
(surgery, radiation therapy).
• Side effects of these treatments include
urinary incontinence, problems with bowel
function, erectile dysfunction and infection.
Prostate cancer surgery increases the risk of
urinary incontinence by 28 percent, and the
risk of erectile dysfunction by 36 percent.
Using PSA to broadly screen asymptomatic men for prostate cancer is not an effective
approach, the task force concluded. But men
with early signs of the disease or a known
family history of prostate cancer should consider PSA testing as an option.
CONTINUED FROM PAGE 51
• Prostate Cancer Foundation (PCF), pcf.org.
• National Cancer Institute, cancer.gov.
• Centers for Disease Control and
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