Conflict of PSA Screening

Prostate cancer screening involves one of two tests: The digital rectal examination for lumps on the prostate and the Prostate Specific Antigen, a blood test that can be elevated in prostate cancer. The problem is that the PSA isn’t always accurate and the digital rectal exam wasn’t always done. The best test is to do the tests together and make an educated guess as to whether or not prostate cancer is there.

PSA alone is not a good enough test on its own for screening for prostate cancer. It was found that elevated levels could be found even when the individual had no cancer at all. It therefore wasn’t a very sensitive or specific test.

No one believes PSA is a great test. High rates of false positives and false negatives are possible and it is acceptable to do watchful waiting as a treatment test. There are serious tradeoffs when it comes to treating or watchful waiting for the disease. Biopsies have their own problems and can miss cancer quite easily. In fact, most people with prostate cancer eventually die of some other disease besides prostate cancer.

Treatments for prostate cancer have been described as horrific, where watchful waiting has not been described as that bad.

PSA tests may be harmful to the patient if there are false positives but these are rare and temporary side effects. Sometimes, PSA testing is stopped after treatment, which is felt to be a good thing by some individual. Some urologists recommend banning insurers from paying for screening of men over the age of 75 to 80 because treatment is clearly more harmful than good for the patient. This is a controversy that is not soon to be over because there are a lot of factors involved in PSA screening, the treatment of prostate cancer and the screening of prostate cancer in elderly men. It is believed that 80% of men over eight already have prostate cancer and do not need any form of treatment. The trick is to figure out which prostate cancer treatment is aggressive and which is non-aggressive.