Despite the evidence, why do people continue to ask for PSA screening? “One factor in the popularity of PSA testing is that it is backed by powerful commercial forces which assiduously promote its benefits. One prominent campaigning group, Us Too! International – which is based in the USA with branches in other countries, including several in the UK – describes itself as a ‘grassroots’ organisation set up by prostate cancer survivors. A glance at its website reveals that it is ‘supported by an unrestricted educational grant’ from Abbott Oncology, a pharmaceutical company that produces, not only PSA testing kits, but a range of drugs for prostate cancer. Given that Us Too! derives 95 per cent of its income from the pharmaceutical industry it is not surprising to find that it recommends annual PSA tests for men.”

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  • Domenico Savatta, MD

    I am a urologist from New Jersey specializing in urologic oncology.

    I have recently posted what I thought was a fair argument of why I favor PSA screening on my blog at:
    http://www.njurology.com/RoboticSurgeryBlog/2006/01/should_we_do_psa_screening.php

    The argument in question cites real data, but it is very one sided.

    You can argue that the people that know the risks and benefits of obtaining a PSA are urologists. 95% of urologists have PSAs drawn on themselves. This is strong evidence that urologists think it is beneficial.

    Although I admit that industry can influence practice habits, I think that USToo is a good resource for prostate cancer patients. I have given several talks at USToo meetings and have listened to some as well. These talks have been fair and not led by drug companies. The nurse that runs my local chapter is understanding and unbiased in my opinion. I dont think that USToo is a cover for drug companies.

  • Anonymous

    But don’t urologists only see specific patients and are likely to say “here, just today I found cancer early”. Urologists see that patients diagnosed early survive longer, but urologists have no way of knowing if it is all due to lead-time bias and greater percentage of non-progressive tumors. So of course urologists are likely to believe in PSA.

    Do you have any way to say if cancers you find are destined to progress or maybe haven’t spread already? In the former case somebody may live his life worrying and die from heart desease or become incontinet or impotent for nothing. In the latter case one just gains extra few years knowing he has cancer rather than enjoying last few “healthy” years of his life.

    Unless you have not just “your feeling” but real epidemiological data you don’t know if the test is saving lives. Because if it is, why isn’t it seen in mortality figures?

  • Domenico Savatta, M.D.

    You are correct about many of your statements, but one fact is that prostate cancer deaths have been coming down for many years.

    One study that thought it was due to prostate cancer can be found summarized here:
    http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Prostate_Cancer_Deaths_Down_Possible_Link_To_PSA_Test.asp

    You were right on the money with:
    >>Do you have any way to say if cancers you find are destined to progress or maybe haven’t spread already? In the former case somebody may live his life worrying and die from heart desease or become incontinet or impotent for nothing. In the latter case one just gains extra few years knowing he has cancer rather than enjoying last few “healthy” years of his life.

    But as a urologist we take care of all patients in all stages of prostate cancer. A few years ago it was common to find out patients had urinary retention from prostate cancer or blocked kidneys and bone pain. We arent seeing much of this kind of problem anymore.

    Also, by removing a prostate one usually has better urination long term, not worse. Less than 10% of surgical patients have incontinence and none of them have blockages due to benign prostate problems.

    I dont think I have the correct answer, I do think patients shoudl here both arguments and decide what is correct for them.

    It would be interseting how many percent of PMDs have their own PSAs done and how many percent of oncologists.

  • Anonymous

    I dont think I have the correct answer, I do think patients shoudl here both arguments and decide what is correct for them.
    I am anon from 5:11 and I absolutely agree.
    I think screening should be an option for everyone who wants it. I also think that the choice of men who don’t want it (and a choice of women who don’t want mammograms) should be respected. Unfortunately in the US, it seems that the latter are often pressured into being screened and I think it is wrong.

  • Clyde

    Kevin, When I was 38 I was diagnossed with prostate cancer. It was through a PSA test that it was found and then comfirmed through a biopsy. So please, dispite the “evidence” you have, continue with PSA testing. I will scream from the highest mountain that I support PSA testing!

  • Hacker

    I am glad my doctor did PSA testing on me – it was the sole tip-off that I might have Prostate cancer. DRE’s showed a normal (though slightly enlarged) prostate, but my PSA was 5.4 and rising. The first biopsy found nothing. 6 months later, with my PSA continuing to rise, my urologist did another biopsy. This time, early-stage, low-grade prostate cancer was found. After researching the options, I’m having my prostate removed via robotic surgery. I’m VERY GLAD that my doctor continued to check my PSA.