Routine PSA screening: still not recommended

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chemotherapyIn an opinion piece published in today s New York Times, Dr. Richard J. Ablin addresses the serious problems with prostate cancer screening. Dr. Ablin discovered the prostate-specific antigen, or PSA, in 1970 (although widespread PSA screening didn t become routine until the 1990s) and it is now the most widely used tool in prostate screenings. However, there is a growing concern that the PSA test has led to overdiagnosis and overtreatment.

While it is true that prostate cancer is the most commonly-diagnosed cancer among American men, with over 200,000 diagnoses annually, and it is the third leading cancer killer in men (about 28,000 after lung and colorectal), there is really no good screening test proven effective at reducing its toll. We ve written before on routine PSA screening and how it does more harm than good. Men often think there is no downside to getting screened, when actually there has been research showing that an estimated 48 men would need to be treated for one life to be saved. Overdiagnosis and overtreatment can lead to millions of unnecessary surgeries, complications (including erectile dysfunction or urinary incontinence), and even death.

In his article, Dr. Ablin points out that recent studies showing PSA screening reduced prostate cancer deaths are facing a big issue the researchers are blocking access to their data. Dr. Ablin wonders why, if the data were strong, researchers wouldn t make them available. It turns out that there has been concern about the methodology and results of the studies, including biased patient treatment and transferring data from other studies into their own data pools.

And finally, many of the senior authors have had conflicts on interest relating to receiving payments from companies involved in PSA marketing, or companies holding patents. Dr. Ablin concludes his piece by saying America needs to continue to push for data transparency especially when lives are at stake.

The bottom line: routine PSA screening should no longer be recommended, as several credible studies have shown that unnecessary prostate cancer screening can be incredibly harmful and does little to save lives.

Another review, in MedPage Today, of the pros and cons of routine PSA screening (and other ineffective methods) can and should be read here, by those interested.