Prostate Cancer and PSA Tests: To Screen or Not to Screen

Each year, millions of men older than 40 have prostate specific antigen (PSA) blood tests as part of routine physical exams to test for prostate cancer. But the utility of these tests in detecting cancer early – and ultimately in preventing death from the disease – has long been debated.

And the picture is, unfortunately, not  getting any clearer – as two major studies recently published in The New England Journal of Medicine, in the same issue, contained somewhat different results.

The studies did agree in one area: Relying only on PSA tests can lead to unnecessary procedures with serious side effects, such as incontinence, impotence, and bowel disturbances that may be worse than the prostate cancer itself – if it even exists in the first pace.

Questions to Ask

Each man is faced with at least three questions involving his prostate health: First, and most basically, should a man have a PSA test as part of the prostate exam? The answer, in my opinion, is yes, but we should consider the results in a context with other important health his-tory information and tests. In some cases a prostate biopsy might be the next step.

This leads to question two: If a biopsy  is negative, but the PSA level is high, what is the best next step? Nothing, monitoring the PSA, or repeating the biopsy? Each patient needs to work with his doctor to answer this question, so it’s important to have a doctor who specializes in urology and who has an independent and open mind.

The third question, assuming a biopsy indicates prostate cancer: Do you treat it? The answer may seem obvious, but it’s not. A growing body of evidence suggests that certain kinds of prostate cancer do not require active treatment because they are small, slow-growing, and unlikely to be fatal.

Moving Forward

You need a sophisticated, skilled urologist to guide you through these questions and decisions. In my view, academic medical centers are well-suited to giving patients objective analysis and treatment recommendations in this complex area.

For a more complete discussion of this issue, visit utswmedicine.org/psatest.

Claus Roehrborn, M.D., professor and chair of urology, earned his medical degree from Justus Liebig University in Giessen, Germany. He received his urology training, as well as finished a research fellowship in urologic endocrinology, at UT Southwestern Medical Center. He sees patients at UT Southwestern in the Urology Clinic. To schedule an appointment, call 214-645-UROL (8765), or 214-645-8300.