Is Prostate Cancer Screening Still Necessary?

No one likes going for that annual physical exam. For many, the anxiety increases when it includes a cancer screening.

For men, that fear can go up a notch when their exam includes a PSA -- the screening for prostate cancer. While once believed to revolutionize the diagnosis of this disease, today the PSA is at the center of debate, frequently charged with leading to unnecessary treatment as well as causing unnecessary anxiety.

"It's a controversial arena -- the PSA is a marker of prostate bulk and size, but it's highly expressed in benign prostate disease as well as cancer -- so in that context it's not a specific marker," says prostate cancer researcher Arul Chinnaiyan, MD, PhD, the S.P. Hicks Collegiate Professor of Pathology at the at the University of Michigan Medical School.

As a result, he says, a PSA score can not only frighten a man unnecessarily, but also lead to overtreatment -- including unnecessary biopsy and even surgery.

"[The PSA] is responsible for hundreds if not thousands of unwarranted biopsies a year, and ultimately overtreatment of incidental [cancers]," says Chinnaiyan.

Moreover, a recent study from the Yale School of Medicine and the VA Connecticut Healthcare System found no evidence that a PSA screening could improve the survival rates of men diagnosed with prostate cancer -- leading many to wonder if the test is even necessary at all.

At the same time, however, prostate specialists like NYU's Herbert Lepor, MD, remind us that not having this test can mean missing an early prostate cancer, and ultimately losing your life.

"People forget that you can die from this disease. Prostate cancer can kill you and right now the PSA is an important way to determine what your risk of dying of prostate cancer is, and hopefully allow you to take steps to reduce that risk," says Lepor, chairman of urology and professor at the NYU School of Medicine in New York.

Indeed, new statistics released by the American Cancer Society (ACS) show that the rate of death from all cancers has declined, suggesting that better screening tools is one reason, particularly in the case of prostate cancer.

And while Lepor acknowledges that sometimes the PSA does lead to an unnecessary biopsy -- and even unnecessary surgery -- still, he says, it's not a screening a man should routinely ignore.

"What you ultimately end up with here is the risk of overtreatment versus the risks of dying from prostate cancer," says Lepor, "and I think most men would rather not die."

Understanding Prostate Cancer and the PSA Exam

The prostate gland is a small walnut-sized organ that sits in a man's pelvis, right behind the pubic bone. The bladder lies just on top; the rectum, just below. The urethra, the tube that carries urine out of the body, runs through the prostate gland, and on either side is a network of nerves that help control sexual function.