Urologist calls for a re-evaluation of PSA for prostate cancer screening. Really?

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Examine your prostate?In yesterday s New York Times, an op-ed entitled Bring Back Prostate Screening called for a renewed interest in and utilization of the Prostate Specific Antigen (PSA) blood test for screening men for clinically-inapparent prostate cancer. The author is Deepak A. Kapoor, a urologist and professor at the Icahn Medical School/Mt. Sinai in New York. He also happens to be chairman of health policy for the Large Urology Group Practice Association.

Dr. Kapoor bemoans the (in his opinion) premature abandonment of the formerly common practice of obtaining yearly PSA levels in most adult male patients in primary care, internal medicine, and of course urology offices. He does note that this change in clinical practice was the result of several large studies indicating that routine PSA screening led to more needless procedures and anxiety than lives saved from prostate cancer. He refers to other studies which were not clear on the risk/benefit of screening. Most important, he points out several improvements in the PSA test that, if not abandoned, would have (he believes) led to a better predictive value for the test, including rate-of-increase and protein-bound vs. free PSA tests.

American Council on Science and Health Senior Director of Medicine and Public Health Dr. Gil Ross had this comment: Without completely dismissing the doctor s points, I d be remiss if I didn t observe that to a hammer, everything looks like a nail. In other words, urologists fell in love with the PSA test, and not just because of the boom in prostate biopsies and related procedures, but because many of them felt that by rooting out every tiny prostate cancer they could diagnose, they were doing a major public health service. Some, like Dr. Kapoor, seem to mistrust the United States Preventive Services Task Force s comprehensive analysis of PSA testing s net benefit they found it wanting: too many false positives leading to too many needless procedures and anxiety; too many false negatives yielding a false sense of security. And of course there s a natural tendency among men well, everyone in fact to want to know if there s any cancer lurking in their tissues, waiting to pounce.

But over the course of the past few years, the reflex to order the PSA has been gradually waning, for good reason. Here s the bottom line: the author has some valid issues regarding newer methods of gaining valid information from different PSA-related tests. I say let s see some studies on those tests, proving that they are actually yielding more benefit than harm. When those studies are published, then--and only then-- should clinicians re-evaluate the benefits of PSA testing.