PSA Testing: Back to the Bad Old Days?

In  October, the U.S. Preventive Services Task Force (USPSTF) openly questioned the value of PSA tests to screen for prostate cancer,  saying there is insufficient evidence to suggest the PSA blood test is useful as a screening method and may do more harm than good.

The recommendation has created lingering questions for the estimated 30 million men who undergo PSAs every year. 

The Doctor’s Tablet presents two sides of the PSA debate beginning with Arnold Melman, M.D., professor of urology at Einstein.  Here are his thoughts on the USPSTF’s recommendation. 

A terrible injustice is being perpetrated on men by the recommendation of the United States Preventive Services Task Force against the use of prostate-specific antigen (PSA) testing. Unfortunately the misguided recommendation, if followed, will set men back to experience the miseries of those with prostate cancer in the pre-PSA era.

In 1970, when I began my career in urology, no accurate blood markers were available to detect prostate cancer. At that time, nearly half of the men who presented with prostate cancer already had metastatic disease in their bones and lungs. They had bladder and kidney obstruction, and significant urinary bleeding and infection. Those complications caused misery and required extended treatment with long hospital stays at great expense to the patient and the government. Since the era of PSA testing began, that scenario has rarely happened.

My urology residents are taught about historical clinical problems that manifested before PSA was available. Yes, it is true that despite PSA tests we cannot cure everyone diagnosed with the disease with surgery or radiation. However, the secondary damage of growth of the cancer at the prostate (such as the blockage and bleeding) is arrested in most men by those therapies. Yes, many may have slow-growing disease that allows other problems to kill them before the prostate cancer does. And, yes, sometimes it is difficult to separate benign from malignant conditions.

But it is critical to understand that early diagnosis as a result of PSA testing followed by appropriate curative therapy greatly improves the quality of life for the majority of those men for many years even if they do develop metastatic disease. This is not mentioned by the task force, which primarily speaks to the issues of survival and cost while neglecting concern for adverse quality of life of untreated or advanced disease.

The pediatricians, public health doctors and internists who compose the panel are not urologists and do not have hands-on experience caring for men with the complications of prostate cancer. The numbers of men with advanced disease will expand if the gains of PSA testing are abandoned or minimized. Until a better, more-specific test is developed, PSA measurement, when used appropriately by knowledgeable people, can help save lives through early diagnosis and appropriate treatment and improve quality of life.

Editor’s Note: Be sure to come back to The Doctor’s Tablet on Thursday, Feb. 23, when we’ll present another side of the debate over the USPSTF’s recommendation.