PSA Screening Controversy: FAQ
What the USPSTF Prostate Cancer Screening Recommendations Mean for Men
What is the benefit of PSA screening?
Advanced prostate cancer is a terrible disease. Every year, some 30,000 U.S. men die of prostate cancer.
The obvious benefit of PSA screening is that it can detect prostate cancer in its early, curable stages.
For the PSA test to save one man's life from prostate cancer, 1,000 men must be screened.
What is the harm of PSA screening?
The PSA test itself is done on blood taken during a routine physical exam, at very little risk to a patient.
Men with suspicious PSA levels may go on to have a prostate biopsy. This is done with a needle; usually about a dozen small "cores" are taken. It's unpleasant, but usually uneventful. Even so, about 70 out of 10,000 biopsies result in infection, bleeding, or urinary difficulties.
Men found to have prostate cancer -- about 25% to 35% of men biopsied -- have a number of options.
One is to closely watch the cancer to see if it gets worse. In this case, the harm is anxiety and possibly waiting too long to get treatment.
But in the U.S., most men opt for one of the various effective treatments for prostate cancer. These treatments are very effective at curing the cancer. But they have a high rate of side effects. Men sometimes are left impotent and/or incontinent.
For every 1,000 men who undergo PSA screening, one will develop a blood clot in his legs or lungs due to treatment, two have heart attacks due to treatment, and up to 40 suffer impotence or incontinence.
After comparing those harms to the benefit of saving one life, the U.S. Preventive Services Task Force calculated that the harms of PSA screening outweigh the benefits.
Isn't it better to find and treat prostate cancer early?
Once prostate cancer is detected, doctors try their best to determine whether the cancer is dangerous. But the truth is in many cases, nobody knows for sure.
Here's what some of the experts say:
Susan G. Fisher, PhD, professor and chair of preventive medicine at the University of Rochester, N.Y.: "Right now we do not have an accurate marker to identify people who have prostate cancer that could eventually cause serious problems for them."
Otis Brawley, MD, chief science officer of the American Cancer Society: "It is very well accepted that 40% to 60% of localized prostate cancers that we cure are in men who did not need to be cured."
Barnett S. Kramer, MD, MPH, director of the office of disease prevention at the National Institutes of Health: "Unfortunately right now we are left with diagnosing a large number of people without precise enough knowledge to spare those who don't need to be treated from treatment."
But a healthy man who is told he has cancer no longer feels like a healthy man. In the U.S., most such men will seek treatment.