The Controversy Surrounding PSA Testing: Limiting It to Men With Symptoms
Prostate cancer is one of the most common cancers affecting men worldwide. According to the American Cancer Society, 1 in 8 men will be diagnosed during their lifetime and 1 man in 41 will die (the second leading cause of cancer death in American men behind lung cancer).
The prostate-specific antigen (PSA) test has been a valuable tool in the early detection and monitoring of prostate cancer, but the debate over the necessity and frequency of PSA testing in asymptomatic men has escalated.
In fact, there is now a growing movement that supports limiting PSA testing to only men with symptoms of prostate cancer.
What Is PSA?
Prostate-specific antigen, or PSA, is a protein produced by the prostate gland. Elevated PSA levels can indicate various prostate conditions, including benign prostatic hyperplasia (BPH) and prostate cancer. Traditionally, PSA testing has been widely recommended for all men, especially those over the age of 50, as a means of early cancer detection.
(Read the Mayo Clinic’s summary of PSA here.)
Why PSA Testing Is Controversial
The idea was that discovering prostate cancer at an earlier stage would lead to better outcomes. However, this approach has come under scrutiny for several reasons.
One of the primary concerns with routine PSA testing is overdiagnosis and the high rate of false positives. Elevated PSA levels can be caused by numerous factors, including infection, inflammation, or even recent sexual activity. False alarms often lead to unnecessary anxiety, further testing, and incorrect diagnosis.
Overdiagnosis occurs when men are diagnosed with prostate cancer that would never have caused them harm during their lifetime, leading to overtreatment and potential side effects. Many men who receive a diagnosis opt for aggressive treatments such as surgery or radiation therapy, which can cause serious side effects like incontinence and impotence, negatively impacting a man’s quality of life without offering substantial benefits in terms of survival or disease progression. Not to forget the unnecessary financial burdens associated with unwarranted cancer treatment.
In addition, the critics of routine PSA testing argue that there is limited evidence to support its widespread use in asymptomatic men. The effectiveness of PSA testing in reducing prostate cancer-related deaths remains a topic of debate—some studies suggest that routine screening may not significantly improve survival rates.
What Led to the Controversy Surrounding PSA?
Given these concerns, the approach of reducing PSA testing to men with symptoms or those at a higher risk is gaining traction.
With targeted testing, men can make choices about their treatment plan with a better understanding of the potential risks and benefits. They can weigh the pros and cons and make choices that align with their values and preferences. In other words, shared decision-making with their medical provider allows for a more patient-centered approach to prostate cancer screening and treatment.
By focusing on testing men with symptoms or those at higher risk, the rate of overdiagnosis and overtreatment may decrease, sparing many from unnecessary medical interventions and their associated side effects.
The goal of researchers and medical providers on both sides of this debate is to improve the overall quality of care and empower men to make informed decisions about their health, which makes PSA testing and its role in the early detection of prostate cancer a complex issue. While PSA testing has undoubtedly saved lives and detected prostate cancer at an early stage for some, it has also led to significant consequences for others.
The movement to reduce PSA testing to men with symptoms or those at higher risk hopes to strike a better balance between early detection and the potential harms associated with routine screening.
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