Will Life Without PSA Testing Cost Lives?

Prostate cancer screening elimination could increase deaths

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Several years ago, the United States Preventive Services Task Force (USPSTF) recommended against men over the age of 75 having prostate cancer screenings using the PSA (prostate-specific antigen) test.

Now the group doesn't recommend the screening for any age.

But won't that cost lives by not detecting cancers at their earliest and most treatable stages?

Yes, says a new analysis. Eliminating PSA testing would likely result in a tripling of the diagnosis of untreatable advanced disease. Looking at it another way, PSA testing could prevent the deaths of 17,000 men.

"Talk to you doctor about prostate cancer screenings."

The USPSTF made its recommendation based on its assessment that PSA testing delivers more harm than benefits, causing men to undergo biopsies that eventually turn out to reveal nothing - but leaving them impotent and incontinent.

Edward Messing, MD, of the University of Rochester Medical Center, and colleagues wanted to determine what the eventual impact of this recommendation might be.

They compared statistics from just before PSA testing became routine (1983-1985) to the current period where PSA testing was widespread (2006 to 2008).

They relied on the Surveillance, Epidemiology, and End Results (SEER) database, the nation's largest database. Researchers focused on cases in which the prostate cancer had already spread to other organs by the time it was diagnosed.

Some 8,000 cases of advanced prostate cancer had been diagnosed in 2008. Prostate cancer that has metastasized can't be successfully treated.

Using a mathematical model they had developed, the investigators then predicted how many advanced prostate cancers would have been diagnosed without PSA testing. That number was 25,000.

"Our findings are very important in light of the recent controversy over PSA testing," said Dr. Messing. "Although there are trade-offs associated with the PSA test and many factors influence the disease outcome, our data clearly indicate that not doing the PSA test will result in many more men presenting with far advanced prostate cancer."

He added, "Almost all men with clinically apparent metastases at initial diagnosis will die from prostate cancer."

The American Cancer Society predicts that about 242,000 men will learn they have prostate cancer this year, and roughly 28,000 will die from the disease.

This research was published in the July 30 in Cancer, the peer-reviewed journal of the American Cancer Society.

Study funding and author disclosures were not available.

Reviewed by: 
Review Date: 
July 30, 2012
Last Updated:
March 20, 2013