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Public release date: 09 April 2009
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PSA - old controversies, new results
The prostate-specific antigen (PSA) test to screen for prostate cancer is the most important issue in men's health. It is also the most controversial. That's because many experts believe prostate cancer is the exception to the rule that early detection of cancer saves lives. In fact, the PSA screening may actually do more harm than good.
The PSA can't tell the difference between the slow growing, harmless prostate cancers and the less common, aggressive, potentially deadly tumors. In fact, the PSA can't even diagnose cancer. Instead, depending on the score, it can lead to a prostate biopsy, which is the only way to detect the cancer. If doctors see cancer cells in the tissue sample, they try to estimate how aggressive the cancer is based on its appearance.
The upside of the PSA is that early diagnosis of aggressive prostate cancers can improve survival. But when screening finds cancers that would never cause symptoms or harm during the patient's lifetime, it results in the major downside of PSA screening — over-diagnosis.
Two much-anticipated studies, the results of which were released last month, were hopefully going to settle the debate over the value of the PSA. While they give us some much-needed answers, we are still a long way from settling the debate: Does PSA screening save lives by allowing doctors to treat aggressive cancers early, or does it harm men who would never die from the disease by subjecting them to the side effects of surgery, radiation, and/or hormone therapy?
After seven years, the American researchers found even though PSA screening increased the diagnosis of prostate cancer, it did not improve survival. There were no real differences in the numbers of deaths in the two groups. European researchers found that PSA screening reduced the relative risk of dying from prostate cancer by 20%.
Despite these major new studies, PSA testing remains a personal decision. But things have changed.
Before – There's no evidence that PSA screening saves lives.
Now – There's good evidence that screening does not save lives.
Before – If a man was undecided about having a PSA test, the best recommendation is to have the test.
Now – Unless a man has a particular reason to ask for the test, the best recommendation might be to skip the test.
The debate will continue, but the playing field has shifted.
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