Prostate cancer screening

Prostate cancer screening remains highly controversial.  The only blood test, the PSA, is perhaps the most inaccurate test that I order.  Part of the problem is that PSA is made by normal prostate glands and it goes up gradually in men with age.  Individuals with prostate cancer may have a higher PSA, but even that is not always true.  A normal PSA level does not rule out cancer, nor does a mildly high PSA rule it in.  Added to this inaccuracy is the uncertainty towards the value of treatment nor which treatment is clearly superior.  Finally, most men who get prostate cancer will not die from that disease so the value for screening is more questionable particularly as one gets older with other medical problems becoming more common.

Two recent studies now suggest that a single PSA test (rather than annually) may be enough of a screen if the result is solidly normal (less than 2, normal usually up to 3.5 to 4).  The most recent study included 86,000 men between ages 55 to 74 and followed for 9 years.  Close to 70% of men had low PSA baseline numbers of less than 2 and for that majority there was no benefits for continued screening as related to death from prostate cancer.  A similar conclusion was made in another large study published in the British Medical Journal.

Unfortunately, this will probably not change the physician community behavior anytime soon where annual PSA tests are done frequently often leading to more tests and invasive procedures.   More and more information however is suggesting this needs to change.

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