Q: My doctor suggests I get a PSA test, but I want to avoid unnecessary treatment. What do you suggest?
A: The United States Preventive Services Task Force recently issued a preliminary recommendation against routine prostate cancer screening using the prostate-specific antigen, or PSA, test for symptom-free men, regardless of age, race or family history.
It didn’t take long for experts on both sides to turn up the volume on their opinions, with many patients, doctors, experts and others claiming that the PSA test saves lives, and those who supported the task force claiming there is little evidence that PSA screening really works.
Many men develop prostate cancer as they age, but it’s a slow-growing disease, and more men are likely to die with it than from it. The result is that it has proven difficult to demonstrate clearly that PSA testing makes a difference. Prostate cancer treatments have serious and long-lasting side effects. Unfortunately, we don’t have a test that will tell us which cancers require treatment or will never cause problems if left alone.
So the question is: Do the benefits of routine PSA testing outweigh the risks and harms of testing and treatment, which include infection, impotence, incontinence and even death in some men? The task force and some experts say “no,” while advocates and other experts say “yes.”
PSA testing is unlikely to disappear in the near future. Hopefully more patients will have open, honest discussions with their healthcare professionals before getting the test so they can make more informed choices rather than just getting the test.
The controversies leave much of the public confused. The sad reality is it likely wouldn’t have been this way if we had only done the right trial before PSA testing became part of our culture.
The lesson: Just because we say it is so doesn’t make it so. Sometimes a little skepticism and evidence can go a long way in helping us understand whether a medical test really works.
—Len Lichtenfeld, MD is deputy chief medical officer of the American Cancer Society. Send questions to firstname.lastname@example.org.