What with elevated PSA’s that do not show prostate cancer, the increased risk of infection from the prostate biopsies, and the question of ‘overdiagnosis’ of mild disease that does not require treatment…the entire PSA issue has become increasingly unclear.
Into that mix, steps the latest study from the NCI (National Cancer Institute).
This study of 77,000 men for 13 years demonstrated no survival benefit for the patients who had PSA screening.
This data is very solid and the practice of ‘routine’ PSA testing has to come into question.
Now, I’ve had abundant experience with this issue, having trained at Hopkins during the “Pat Walsh” era when radical prostetectomy was perfected, while at the same time the PSA was just coming into broad use. Certainly, 20 years ago, virtually all of my patients with PSA elevations had prostate cancer, but over the ensuing years, with ongoing screening, it has become increasingly evident that elevated PSA’s generally do not have prostate cancer and that many patients have undergone invasive testing to prove they are ‘clean.’
At this point, I am going to have a more complete discussion with patients about the pro’s and con’s of PSA testing and would recommend a PSA in patients with:
Family history of prostate cancer
Questionable findings on prostate exam
This is a fluid situation, but I think the time is coming to rethink what we’ve been doing and to change course with a more measured approach.