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Prostate cancer screening: Why can't doctors agree?

Story highlights

  • Government panel says the screenings do more harm than good
  • A new study says more men will be diagnosed with advanced cancer without testing
  • Public health experts have turned away from testing
  • Many doctors feel testing has helped their patients

If you're wondering why experts still can't agree on prostate-cancer screening, you're not alone.



"Almost all men with clinically apparent metastases at initial diagnosis will die from prostate cancer," urologist and study author Edward Messing told reporters, as he explained the importance of his study.

The new study reflects a broader divide in the medical community, between public health experts who have largely turned away from PSA screening, and many practicing clinicians who feel the test has helped their patients immensely. Prostate cancer screening: Men should forgo PSA testing, panel advises



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The same European trial that found lower cancer mortality with PSA testing also found that, to save just one life through screening, an extra 37 men would need to be diagnosed with prostate cancer and treated. Many health experts think that's too much risky treatment to justify the results.

Value of mass prostate screenings questioned

So when the government advisory panel — the U.S. Preventive Services Task Force — recommends against routine PSA testing, it's making a judgment call. It's saying that, for most men, the (albeit small) risk of sexual dysfunction and urinary leakage from eventual treatment is not worth it, given the even smaller chance that PSA testing could save your life. But that decision does remain a judgment call. It depends on how much you value certain quality-of-life measures versus how much you value having any life at all. Surgery for early prostate cancer doesn't save lives

As for the new paper this week, which suggests that three times as many men would be diagnosed each year with metastatic prostate cancer if it weren't for PSA testing, that study is published in the journal Cancer — and its numbers deserve a little explanation.

To calculate the total number of metastatic cases we'd get without screening, the study takes today's population of the United States and applies the rates (broken down by age and race) of advanced-stage prostate cancer that were observed before PSA testing was introduced — that is, the rates way back in 1983-85.

In other words, it tells us what the current U.S. population would look like if today we faced the same risks that Americans faced in the '80s; it finds we'd have roughly 25,000 U.S. men diagnosed with advanced-stage prostate cancer each year compared to just 8,000 today. But is going back in time 30 years really the same thing that we'd get if we abolished PSA testing today? Who knows?

The rate of new diagnoses of all cancer types combined has been falling consistently in recent years. However, prostate cancer is one of the few cancers that's not strongly linked to smoking (and falling cigarette consumption over the past 40 years is a major reason for falling cancer rates). It is, however, linked to obesity, which has been on the rise since the 1980s.

'Cutting' your risk of prostate cancer



Many doctors do have very strong opinions, though. As a patient, if you're deciding whether to get a PSA test, or whether not to get a PSA test, remember you do have a right to your own opinion too. There's no easy answer. Prostate cancer screening: What you need to know

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Prostate cancer screening: Why can't doctors agree?