Should You Be Screened for Prostate Cancer?
Bernie Wooden’s story is hardly unique. The prostate-specific antigen (PSA) test used to be given to men fairy routinely. And men around the country—and the world—believe they’re alive today because their doctors noticed a sudden increase in their PSA levels. But in 2012, the U.S. Preventive Services Task Force (USPSTF) issued a recommendation against doing PSA screening for prostate cancer, saying that the harms of the test outweigh the benefits. That recommendation ignited a huge—and not always civil—debate among people who work in men’s health.
Some supported the USPSTF recommendation, saying that prostate cancer typically grows very slowly and men are more likely to die with prostate cancer then from it. These people also pointed out that the PSA test leads to overdiagnosis, and that an abnormal PSA test could drive a man to pursue unnecessary treatment or surgical procedures. Side effects, many of which are permanent, include urinary incontinence, erectile dysfunction, and bowel dysfunction.
Even so, proponents of the PSA test point out that prostate cancer is the most common cancer other than skin cancer in men, and that while some prostate cancers are slow developing, others are extremely aggressive. The proponents also note that only healthcare professionals can order surgery or other treatments and that not having PSA measurements removes an important data point that could help men and their providers assess the patient’s risk, evaluate all of their options. In some cases, including Berne Wooden’s, that treatment plan might include medical procedures such as radiation and surgery. For others, the best approach is to simply “watch and wait,” also called “Active Surveillance.” In either case, the decision is made by the patient, his family, and his doctor.
When evaluating the risks vs. rewards of a particular health screening, experts often look at the number of patients who would have to be screened in order to save one life. For prostate cancer, that number used to be very high. However, thanks to more accurate diagnostic techniques and looking at the impact of screening at longer time points, the ratio of screenings to lives saved is now in the same range for prostate cancer as it is for breast cancer. And while the Task Force recommended fewer mammograms for women, the USPSTF didn’t go as far as recommending that they not be done at all.
The big question is whether getting a PSA test will help men live longer. According to the USPSTF, “the precise, long-term effect of PSA screening on prostate cancer–specific mortality remains uncertain.” Dr. Steven R. Patierno, a professor at the Duke University Medical Center and Deputy Director of the Duke Cancer Institute, agrees that more research is needed, but he disagrees with the recommendation against using the PSA screening at all.