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The Value of PSA Testing in Men

Of all the medical controversies that have received significant media attention within the last year, the value of PSA testing in men without symptoms certainly ranks near the top of the list.   Recently U.S. Preventative Services Task Force recommended against PSA based screening and then an American Urological Association panel changed its guideline recommendations stating that routine PSA testing could not be recommended for men younger than 55 or older than 69.   The panel also recommended offering the blood test every 2 years instead of annually for men between these ages. This came as a shock to men and physicians alike for, since the widespread use of this simple blood test that measures a protein uniquely secreted by the prostate, the death rate from prostate cancer has declined nearly 40%.   And, prostate cancer remains the number 2 killer in men.  Certainly, most men know others who have succumbed to this cancer.

So what should a man do?  Most would agree that the PSA test remains a useful tool in the detection of prostate cancer and very likely saves lives.  The issue is that the medical profession has only just begun to study this.  A major problem with the studies used by the USPSTF to reach its verdict is that they were not of significant duration; because prostate cancer may progress more slowly than other cancers, outcomes data must be collected for at least 10 to 15 years.  Interestingly, the mortality benefit of screening becomes more apparent the longer the study.

The other concern is the so-called downstream effects of PSA screening, meaning the risk of further testing if the test is abnormal.  For example, the risk of an infection resulting in hospitalization after a prostate biopsy is 1-4% nationwide.   What is often not mentioned, however, are the risks of not diagnosing prostate cancer, especially in men expected to live at least 10 to 15 years.  Prostate cancer can metastasize to other organs causing urinary obstruction, severe, debilitating bone pain, and death.

Because of the controversial nature of this blood test, CareMount Medical suggests you discuss the value of the test with your physician. That way you can make the choice about whether to have the test with all the proper information.