The PSA Test Controversy: A HealthCentral Explainer

CRegal Editor
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    What is the PSA test?

     

    Testing the amount of Prostate Specific Antigen (PSA) in the blood can help diagnose prostate cancer.  PSA is a protein in the blood produced by prostate cells; a dramatic rise in the amount of PSA can indicate problems with the prostate gland, including prostate cancer, enlarged prostate, prostatitis or prostatic stones.  Though PSA levels rise on their own even in healthy men, an increase  can indicate a greater problem.  Most doctors use the PSA test as a preliminary test and, depending on the results, can be followed by more invasive diagnostic tests, such as a biopsy.

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    Why is the PSA test controversial?

     

    In August 2008, the U.S. Preventive Services Task Force, an independent panel of experts that advises the Department of Health and Human Services, concluded that, "the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years."  It also reported that PSA screening had no value for men over 75.  In short, it suggested, the screening was not of much use. 

     

    In 2011, this was updated to state that healthy men should no longer have a PSA test at all.  The Task Force concluded that the test does not save lives and may lead only to more testing, but not necessarily better results.  The PSA test also can also cause side effects, including pain, impotence and incontinence. 

     

    However, many doctors still stand by the usefulness of the test and believe that many lives have been saved because of it,  including HealthCentral's Prostate Health Expert Dr. Jay Motola.

     

    What does the latest evidence show?

     

    Contrary to what the USPSTF found, a new report published in the New England Journal of Medicine in March 2012 found that the PSA test can reduce mortality rate by up to 30 percent.  However, Dr. Fritz Schroder, the lead author on the study, stated that "there's a 30 percent chance that a cancer found is insignificant and the patient may be confronted with the side effects of the treatment unnecessarily."

     

    The jury is still out on this one.

     

    Are there times when the PSA test is appropriate?

     

    Yes.  Even if the PSA test is no longer recommended for all men, it still has its uses.  Most PSA tests are for men 40 to 75 years old, and men with a family history of prostate cancer should be screened.  A PSA exam can also be a follow-up to a digital rectal exam if the doctor finds abnormalities in the prostate gland. 

     

    The most recent study on the issue, published in May 2012 in the Canadian Medical Association Journal, supports screening for younger men or men at high risk of prostate cancer.  This report also said that the PSA test should not be abandoned.

     

    What does this mean going forward?

     

    Clearly, the PSA test is still very controversial.  Major influential organizations have recommended against using the test and have argued that it doesn't help much in preventing  deaths from prostate cancer.  On the other hand, many doctors swear by it and, as evidenced above, studies do show that the test can be successful. 

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    The USPSTF recommendation likely means that insurance companies will stop covering the PSA test for otherwise healthy men.  However, this does not mean that men are now more vulnerable to prostate cancer.  There are still several other exams that will be utilized, and the demise of the PSA test may not mean a rampant rise in prostate cancer mortality rate.

     

    That said, the PSA test can still be an important step in diagnosing prostate cancer, though it may not be used as often as it has been in the past. 

     

     

     

    Sources:

     

    ABIM Foundation. (2012).  Choosing Wisely. Retrieved from http://choosingwisely.org/?page_id=13.

     

    Canadian Medical Association Journal. (2012, May 8). "Younger And At-Risk Men Benefit From PSA Screening To Detect Prostate Cancer." Medical News Today. Retrieved from
    http://www.medicalnewstoday.com/releases/245092.php.

    Digital Rectal Exam.  (2 February 2011).  A.D.A.M. Medical Encyclopedia.  Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/007069.htm

Published On: May 08, 2012