Urologists say most men may skip PSA test for prostate cancer

Urologists say most men may skip PSA test for prostate cancer




The PSA test measures prostate-specific antigen, an enzyme that helps liquefy semen. Here's a little background from a 2012 Los Angeles Times story:




PSA testing has been falling out of favor in recent years. Many health experts say the test isn't very good at helping doctors figure out which men have prostate cancer that threatens their lives and which men have cancers that are so slow-growing that they're essentially harmless. However, the biopsies and treatments that follow a PSA test can cause significant health problems.


At the time, the American Urological Assn. expressed "outrage" and called the task force's advice "inappropriate and irresponsible."

"There is strong evidence that PSA testing saves lives," Dr. Sushil S. Lacy, then president of the association, said in a statement.

Now the association is taking a more measured approach. The new recommendations are based on medical evidence from clinical trials instead of the "consensus opinion" of urologists, as was done in the past.

The guideline acknowledges that "prostate cancer screening itself is associated with a number of potential harms, both psychological and physical." For instance, the biopsy can cause pain, infection, blood in the urine or in semen and other side effects.

Some of those side effects are psychological, the guideline says: "There is considerable distress involved in the decision-making process, the biopsy and deciding among treatment options. Along with the stress due to PSA screening and unnecessary biopsies, the diagnosis of prostate cancer alone may incite severe psychological stress with one study showing an increased rate of suicide and cardiovascular events in newly diagnosed men."

The new guildeline also acknowledges that many men get treatment that's too aggressive for their disease. "Although prostate-cancer-specific mortality and the need for related palliative care is decreased by screening, quality of life may be impaired as a result due to lasting impairment in urinary, bowel and sexual function," the guideline states. "Thus, personal preferences should play a large role in both a decision to screen and in prostate cancer management if diagnosed."

With all this in mind, the association says that:








"There is general agreement that early detection, including prostate-specific antigen screening, has played a part in decreasing mortality from prostate cancer," Dr. H. Ballentine Carter, chairman of the American Urological Assn. panel that developed the guideline, said in a statement. However, he added, "it's time to reflect on how we screen men for prostate cancer and take a more selective approach in order to maximize benefit and minimize harms."

You can read the full guideline online here.

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