PSA screening for prostate cancer will continue

Is the tide finally turning on PSA screening for prostate cancer?

Search “PSA prostate screening” on this blog, and you’ll find a variety of opinions on this controversial issue. There’s no definitive data that PSA screening saves lives from prostate cancer, and indeed, can lead to further, invasive, tests that can cause men significant discomfort.

Medical societies are divided on the issue; primary care groups like the USPSTF recommend against it for older men, while the American Urological Association continues to recommend screening.

In a strongly-worded op-ed in the New York Times, Richard Ablin, also known as the founder of the PSA test, bemoans how our health system has twisted its use. “The test’s popularity has led to a hugely expensive public health disaster,” he writes.

Who’s responsible? According to Dr. Ablin, it’s the drug companies: “So why is it still used? Because drug companies continue peddling the tests and advocacy groups push “prostate cancer awareness” by encouraging men to get screened.”

He’s leaving out other culprits. If the public is to be convinced of the PSA test’s fallibility, public figures need to get off the bandwagon. That includes prominent prostate cancer survivors like Senator John Kerry, who implores the public to be screened, without explaining the possible ramifications.

And what of the legal consequences? Dr. Daniel Merenstein dutifully explained the risks of PSA screening to a patient, but got sued for his efforts and was forced to settle.

Maybe he was ahead of his time.

Until we can better educate the public on PSA’s risks, and protect doctors from malpractice who curtail the test, PSA screening will continued to be rampantly ordered.

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  • http://theprostatedecision.wordpress.com john mchugh

    the only way to view this situation is if it were you. your psa is high, you have had a rectal exam and then you decide. the average person placed in ths situation who is in his 50′s most likely is compelled to have a biopsy. as patients age they become less so. really the numbers of all the association and so forth are really meaningless. the question remains and is the issue with the patient in front of his doctor is “what would you do?” that is where the issues regarding screening become real and relevant.

  • http://drpullen.com Edward

    In my practice I try to present the facts, and men universally have PSA testing. Men are just not ready to accept that there is nothing they can do to prevent dying of prostate cancer. This may be a futile grasp for reassurance, may be more harmful than good, but men at this point need to feel their doctor is doing his/her best for them, and that they are doing what they can. Until something better comes along, we are stuck with the PSA test.

  • http://www.ConquerProstateCancer.com Rabbi Ed Weinsberg, EdD, DD

    Hi, Dr. Kevin,
    A blanket condemnation of PSA readings makes no sense at this time, so I vote with the AUA that prostate cancer awareness projects reaching out to men at age 40m to get a PSA baseline reading if a man’s doctor concurs, is sensible. I guess I’m one of those dreaded prostate cancer awareness promoters you and others have condemned, as evidenced in my national prostate cancer awareness tour, noted in my blog conquerprostatecancer.com, and in my book of the same name.
    Promoting PSA screening is essential whether by me or by do-gooder Liberals like Senator Kerry, providing we point to the risks and benefits of PSA+biopsy+various treatments. This includes recognizing the by-and-large prostate cancer when found is not a death sentence, but it can cause pain and stress that needed to be attended to. As such the PSA is the best we have as a preliminary indicator of whether a biopsy and treatment are called for, until a more reliable biomarker is discovered and scientists discover how to ascertain if a particular tumor is likely to become more aggressive.

    After ruling out the four other causes of high PSA like prostatitis, BPH, sex within 48 hours before testing,and bike riding (like one dentist told me he did enroute to a scary PSA reading!), we can assume the PSA has some value, especially in gauging if volatility after an initial base reading should be explored more fully.

    As a case in point the value of the PSA screening has been proved in such cases as that of a vigorous “healthy” 40 year old man who was totally asymptomatic last year, but had a routine first-time PSA screening, only to find he had advanced prostate cancer that needed immediate attention via surgery (of questionable value) and chemotherapy and radiation (of greaer value). Under such circumstances why throw out the baby with the bathwater?!? Besides, even Dr. Ablin admits that that without the PSA there would be no way to monitor telltale volatility or recurrence. He have come across as voicing a blanket disapproval of PSA use, but that’s hardly the case. Please don’t overstate what he overstated!
    Yes, as your post’s title ruefully stated , PSA screening will continue, but for good reason!

  • Sue

    The statistics for PSA screening are more nightmarish than the mammography screening. The probability for overtreating is higher for prostrate cancer than mammography and at least I would only lose a breast, not my sex life. One again anecdotal evidence trumps science. Of course the urologist want men to get tested…more cash for them.

  • http://www.ConquerProstateCancer.com Rabbi Ed Weinsberg, EdD, DD

    Sue comments that men who go through a PSA and subsequent biopsy and treatment will lose their sex life in a way that is “more nightmarish” than women whose mammograms lead only to the loss of one breast and not the loss of their sex life.

    Actually a mastectomy and a prostatectomy (for 2/3 of men who then get ED) can lead to similar outcomes and hurdles that in turn can be largely overcome with considerable effort.

    For instance consider what some authors have presented at http://www.mamashealth.com/sexualhealth/masectomy.asp, where they state that, “Mastectomy, a surgery that removes one or both breasts as a means to prevent the spread of cancer, can cause serious emotional and psychological toll. Poor body image, low self-esteem and low sex drive are only some of the psychological effects of losing a body part that is long considered an erogenous zone. Losing one or both breasts might cause a woman to feel differently about her sexuality and greatly affect her physical intimacy with her partner. ”

    The authors of these comments, though, go on to explain how a woman who has breast cancer can eventually re-engage sexually by acquiring various techniques over time, including learning to communicate her needs and fears more effectively. I’ve advised men to do precisely the same in some of my articles as well as posts at conquerprosatecancer.com

    Agreeing to get PSA screening, which often leads to a biopsy and surgical treatment, undeniably – more often than not, results in overtreatment of men who prefer to play it safe and eliminate possible prostate cancer at all costs. But such men can learn to overcome sexual dysfunction just as much as women can following a mammogram and breast surgery.

    It’s neither wise or helpful to decry PSA screening because of allegations that it can lead to more sexual difficulties than a mastectomy.

  • http://www.ConquerProstateCancer.com Rabbi Ed Weinsberg, EdD, DD

    Here’s an important addendum to ponder:
    It’s not true that “The probability for overtreating is higher for prostate cancer than mammography.” The opposite is the case, since 1 of 1900 women who get a mammography will die of breast cancer, versus 1 of 49 men, who will die after getting a PSA screening followed by active treatment such as surgical removal (a prostatectomy).

    Consider this quote too: “In the case of breast cancer, an analysis of randomized trials with some 247 000 women aged 40 – 74 years showed that for every 1000 women who participated in screening, 3.9 diagnosed with breast cancer died, compared with 5.0 among those who did not participate.” (J. Natl Cancer Inst 2009;101:1216–1220)

  • Sue

    “The opposite is the case, since 1 of 1900 women who get a mammography will die of breast cancer, versus 1 of 49 men, who will die after getting a PSA screening followed by active treatment such as surgical removal (a prostatectomy).”

    You seem to have misinterpreted my comment. 10 women will be diagnosed with breast cancer and unnecessarily treated for every 1 women saved. 73 men will be treated to save 1 man.

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