PSA test not so useful

In a major about-face, a leading medical group recently questioned the value of PSA tests, a common marker used for prostate cancer. The American Urological Association came out with new guidelines significantly restricting the types of patients who should have this lab work done.

The PSA is a blood test which searches for a “marker” said to be sensitive for prostate cancer. For many years, most doctors have been recommending that PSA testing be done on men over the age of 50. Under the new guidelines, however, the testing is not recommended for men under the age of 55, and even for men between 55 and 70, it is only recommended that the patient and doctor have a discussion about PSA testing, not that men necessarily have the test. For men 70 and older, it is generally not recommended at all. The main exception to these guidelines is people who have a family history of, or otherwise are at high risk for, prostate cancer.

Urologists are the medical specialists who usually take care of prostate cancer. Why has their organization “changed” it’s tune on PSA testing. Primarily because recent studies conclude that the benefits of PSA testing are often outweighed by the risks. For example, if a PSA test is elevated, it usually leads to a man undergoing a biopsy on their prostate, but that biopsy can cause various complications, primarily bleeding and infection. Even worse, we once had a case where our client’s biopsy specimen was mixed up with the specimen of another patient and as a result, our client was told he had prostate cancer when he really didn’t. He ended up having surgery which left him impotent. The new guidelines basically conclude that the prevalence of these side effects outweighs the chances of detecting cancer and, even if cancer is present, the chances of improving overall survival are slim.

Even in those cases where the biopsy is positive, the urology group concluded that this often leads to men being “over-treated” for their cancer, i.e., undergoing more aggressive treatment than they really need. The surgery done on those patients who have prostate cancer often leads to serious complications including sexual impotence, and the guidelines basically conclude that for a lot of men their overall prognosis is not much different whether they do or don’t have the surgery.

The bottom line is that if you are under the age of 55 you shouldn’t be having PSA testing unless you have a peculiar risk for prostate cancer, and if you are over the age of 55, you should only have PSA testing if you and your doctor decide it is in your best interest.