PSA: To Test Or Not To Test, That Is The Question

For years doctors have been advising men over 50 to have the PSA levels tested every year, and if they are elevated, do further investigation.  That often means a biopsy.  I remember a time about 15 years ago, when a doctor recommended a biopsy on Ron.  As if that wasn't bad enough, he had to wait weeks for the results.  That's cruel and unusual.  Times have changed, and many doctors today choose to skip the PSA test altogether, in older men.

The reason for the changed in protocol is because of multiple factors.  First, the blood test often produced a false positive, and caused other tests to be performed (like biopsies) that could lead to complications.  Second, quality of life might be severely compromised with surgery or other treatment.  Doctors have determined that in many cases the possibility of negative results outweigh the benefits of surgery.  This is according to the ACP, American College of Physicians.

"Prostate cancer never becomes clinically significant in a patient's lifetime in a considerable proportion of men with prostate cancer detected by the PSA test," says a committee from the ACP.  "They will receive no benefit and are subject to substantial harms from the treatment of prostate cancer."  The decision as to whether to test or not to test should be a shared decision between patient and doctor, and the patient should make his decision after being fully informed of the benefits and harms.

High risk men, like African-American men and men with a family history of prostate cancer, should also be informed of the risks and benefits and allowed to participate in the decision making process, according to new guidelines.  Clinicians should address certain key issues with every patient:  PSA testing is controversial, PSA can detect prostate cancer, but for most men, the harms outweigh the benefits, few prostate cancers prove to be aggressive and cause death, most men who are screened do not develop prostate cancer and die of something else, PSA testing prevents about one prostate cancer death per 1,000 men screened.

So men, next time you go in for a physical, talk to your doctor about PSA testing.  Opinions will definitely vary among physicians, but even those still opting to test, should present the pros and cons to the patient, so he can make an informed decision.  This is the age of patient involvement in treatment and transparency.  We need to know the facts before deciding, and it is up to the physician to provide the facts to each and every patient.