The U.S. Preventive Services Task Force (USPSTF) recommends against PSA (prostate specific antigen) screening for prostate cancer. The task force currently gives PSA screening a grade D, meaning that there is moderate or high certainty that the PSA test has no benefit or that the harms outweigh the benefits. This recommendation was first issued in 2011.
What’s wrong with the USPSTF guidelines?
In regards to population screening, the African-American male population is ignored, as well as the effect of family history and morbidity associated with prostate cancer. However, African-American men are 56 percent more likely to develop prostate cancer and more than twice as likely to die from the disease compared to Caucasian men. They are also more likely to develop aggressive prostate cancer.
Instead of focusing on the benefits of PSA screening and how much it has actually helped the health care system, their recommendations focus on the complications of treatment, such as incontinence and erectile dysfunction. However, these complications depend on how experienced the surgeon is that you are being treated by.
The USPSTF is made up of 16 volunteer members who are experts in prevention, evidence-based medicine, and primary care. Their fields of practice and expertise include behavioral health, family medicine, geriatrics, internal medicine, pediatrics, obstetrics and gynecology, and nursing. However, no one on the USPSTF has actually treated patients with prostate cancer.
Prostate cancer mortality was on the decline before the USPSTF issued its recommendation. Since incorporating the PSA test, there has been a 40 percent reduction in prostate cancer mortality in the United States.
The USPSTF also ignores how the PSA has actually been valuable and has helped the health care system. Prostate cancer mortality was on the decline before the USPSTF issued its recommendation. Since incorporating the PSA test, there has been a 40 percent reduction in prostate cancer mortality in the United States.
Pros of PSA screening
- PSA screening can help you detect prostate cancer early
- Prostate cancer is easier to treat and is more likely to be cured if it's diagnosed in the early stages of the disease
- PSA testing can be done with a simple, widely available blood test.
- Knowledge is power. Having a PSA test can provide you with the comfort of knowing that you don’t have it or that you do and now have options to have it treated.
- The number of deaths from prostate cancer has gone down since PSA testing became available.
Cons of PSA screening
- Prostate cancer can be slow-growing and never spread beyond the prostate gland.
- Not all prostate cancers need treatment or treatment right away.
- PSA levels may be elevated when cancer isn't present or may not be elevated when prostate cancer is present.
- Being diagnosed with prostate cancer can cause anxiety and confusion. This can make can make decision making for non-life threatening cancers complicated.
- It's not yet clear whether the decrease in deaths from prostate cancer is due to early detection and treatment based on PSA testing or due to other factors.
What people should know about PSA screening
- Screening doesn’t lower your risk of having prostate cancer; it increases the chance you’ll find out you have it.
- PSA testing can detect early-stage cancers that a DRE would miss.
- A “normal” PSA level of 4.0 ng/mL or below doesn’t guarantee that you are cancer-free; in about 15% of men with a PSA below 4.0 ng/mL, a biopsy will reveal prostate cancer.
- A high PSA level may prompt you to seek treatment, resulting in possible urinary and sexual side effects.
- Conditions other than cancer, such as benign prostatic hyperplasia and prostatitis, can elevate your PSA level.
Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital and professor of urology at Hofstra North Shore-LIJ School of Medicine. He is a medical correspondent for the Fox News Channel's Medical A-Team and the chief medical correspondent for am970 in New York City. Learn more at roboticoncology.com. Visit Dr. Samadi's blog at SamadiMD.com. Follow Dr. Samadi on Twitter and Facebook.