The usefulness of PSA screening among healthy men

Our study did not find that screening with prostate-specific antigen (PSA) or digital rectal examination was effective in reducing mortality. Based on these results, and previous research, men shouldn't simply avoid or seek prostate cancer screening; the issue isn't "black and white." Rather, they should recognize that substantial uncertainty exists regarding the usefulness of PSA screening among healthy men, and the limitations of the test should be discussed with their doctor.

In this context, doctors should mention that the PSA test isn't perfect, and that screening may lead to possible harm as well as potential benefit. The benefits include the potential for improved survival in some men. The harms include possible treatment-related side effects, including incontinence and impotence, for therapies that may be unnecessary (for slow growing tumors) or ineffective (for aggressive tumors). In addition, if the PSA test is positive, but cancer isn't found, subsequent anxiety and follow-up testing can worsen a patient's quality of life.

Accordingly, screening may still be considered for men with strong fears of prostate cancer, and by those who are more willing to accept the risk (if prostate cancer is found) of treatment complications including incontinence and impotence. Screening is less appropriate for men who are more concerned about the questionable usefulness of the test than their relatively small risk of developing aggressive prostate cancer, and by those who have strong preferences to avoid treatment complications.

Bibliographical reference:

Concato J et al.: "The Effectiveness of Screening for Prostate Cancer", Arch Intern Med. 2006;166:38-43

John Concato

Clinical Epidemiology Research Center, Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut