Should PSA Screening to Detect Prostate Cancer be Routine?
Despite health care experts having claimed PSA testing to be the best available method to screen men for prostate cancer, there has been a long standing debate surrounding its use in regular screening.
PSA screening can create false positive test results, meaning men can be made aware of cancers that are not actually present. In addition, critics claim that the test can lead to over diagnosis, compelling men to volunteer for unnecessary treatment.
Prostate specific antigen is a substance created by cells in the prostate gland. High levels of this compound can indicate the presence of prostate cancer, and a man discovered to have such levels is likely required to undergo a biopsy to determine whether he has the cancer.
However, elevated PSA levels can also be indicative of less harmful conditions, such as prostatitis or an enlarged prostate. In addition, PSA testing is unable to determine the difference between aggressive and benign prostate cancers. This leads many to question the test’s accuracy.
Prior research has estimated that between 17-50% of men diagnosed with prostate cancer through PSA testing have benign tumors that would not have led to symptoms throughout their lifetime. This indicates that many men may undergo prostate cancer treatment – such as surgery, radiation, or hormone therapy – that is unnecessary, and can lead to serious complications, including erectile dysfunction and urinary incontinence.
These factors have supported recommendations against routine prostate cancer screening. In 2012, the US Preventive Services Task Force issued a recommendation against PSA-based screening for prostate cancer for men of all ages that are asymptomatic.
Many in the medical community were critical about these new guidelines. In a response published in the Annals of Internal Medicine, a group of prostate cancer experts claimed, since considering that prostate cancer does not often present with symptoms in its early stages, eliminating reimbursement for PSA testing would take us back to a time when prostate cancer was only discovered in its most advanced and incurable stages.
The American Cancer Society does not provide guidelines that support routine PSA screening for prostate cancer. Instead, they claim that men must make their own informed decision with their doctor about whether or not they should receive a screening for prostate cancer.
So many conflicting studies and views on PSA testing, it is no surprise that health organizations are undecided about providing recommendations for such screening. The CDC , who claims to support the USPSTF recommendation against PSA screening for prostate cancer, also support the right of the patient to make their own decisions regarding prostate screening and their health care.
Written by Elijah Lamond