Friend or Foe? PSA Screening for Prostate Cancer

Wanna start an argument among physicians?  Get a group together and ask them about their opinion regarding screening for prostate cancer with the blood test known as PSA (prostate specific antigen).  Chances are you'll have to separate normally professional human beings from morphing into mixed martial arts combatants.

If you haven't already heard, the United States Preventive Services Task Force (USPSTF), the same group that raised a ruckus 2 years ago with its mammogram recommendations, just released its evidence review regarding prostate cancer screening in the Annals of Internal Medicine last Friday.  Their conclusion?  "Prostate-specific antigen–based screening results in small or no reduction in prostate cancer–specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary."  

Well, that's the evidence summary.  What is the USPSTF's recommendation in response to the evidence?  In their draft statement, they recommend "against prostate-specific antigen (PSA)-based screening for prostate cancer. This is a grade D recommendation."  This is a significant change from their 2008 statement that insufficient evidence exists to assess balance of risk vs benefit.  Luckily, they'll be open to public input & comment tomorrow (Tuesday).

But don't take it out on me, at least not just yet.  Remember, I'm just reporting the news.  Might I suggest that you read an interesting article published in the New York Times Magazine last Wednesday?  Make sure you have some time as it's not a short read but gives some very interesting history on the PSA test.  Then read an article published the following day in the New York Times' Health section.  Finally, read the information published by The NNT Group.  

Assuming that you haven't been diagnosed w/prostate cancer yourself or personally know of anyone with it, these 3 articles will most likely sway you against checking your PSA annually.  Hopefully, it will give your physicians pause against just automatically checking a box without discussing the ramifications of an abnormal test result.  If you're in the other group, these articles will just be fighting words.

However, let me point out that these articles & recommendations don't apply to men w/symptomatic prostate disease or an abnormal digital rectal (prostate) exam.  I would also posit that this draft recommendation doesn't apply to any man who's receiving testosterone therapy.  While the evidence shows that testosterone doesn't cause a benign prostate to become malignant (cancerous), testosterone might unmask latent (hidden) disease, although I suspect that this, too, is very unlikely.  

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