Prostate cancer is relatively common, occurring in roughly 8 out of 10 men. According to the latest data, approximately 1,000 men need to undergo Prostate-Specific Antigen (PSA) screening to benefit one man’s length of survival. Recent research suggesting PSA screening does not improve the longevity of a man’s life has sparked new widespread interest in PSA testing. Unfortunately, the message distilled from that research is that PSA testing is inaccurate and useless, and it suggests that men should forego PSA screening. The media has not discussed that the PSA screening is a controversial test, and it is not everyone’s opinion that men should not get a PSA test.
PSA testing spawned in the early 1980s, and the course of prostate cancer has changed dramatically as a result. While hospitals once dedicated entire floors to patients who were paralyzed from prostate cancer that spread to the backbone, now a typical urologist rarely sees any sign of metastatic prostate cancer. Additionally, when patients undergo surgery to remove the prostate, surgeons are now finding much less local spread of cancer and better odds of removing all of the cancer rendering a patient a complete cure when compared to surgery before PSA testing. Rarely does a patient die from prostate cancer nowadays, which is very different from prostate cancer outcomes historically.
The data clearly demonstrate that PSA screening has transformed prostate cancer from a diagnosis that is potentially devastating or life threatening to something that is more a nuisance. The controversy of PSA screening lies in the fact that many men will develop prostate cancer and would live their entire lives without ever knowing about it if it weren’t for PSA screening, which leads to overtreatment of the disease.
So, how do I sift through this information and fit it into my practice? It only takes meeting one patient who has metastatic cancer from a very preventable disease to become frustrated with a blanket statement that PSA screening is not beneficial. Doctors need to have a discussion with their patients about the risks and benefits of PSA screening.
The biggest impact these studies have had on my practice is the way I manage prostate cancer, rather than the way I diagnose it. What has been born out of PSA research is that we can be comfortable observing much more prostate cancer than we were previously. I still recommend routine PSA screening for prostate cancer diagnosis. It is a simple blood test with little direct risk. It may lead to a biopsy, but then a patient will know if he can be safe on observation or whether he would benefit from intervention. Without that, people are rolling the dice and declining cheap easy information that may be useful.