The Future Of Prostate Cancer Testing

For years, men “of a certain age” were advised by their doctors to get tested for levels of a compound called PSA (prostate-specific antigen). The theory was that a diseased prostate would produce more of this compound, so by finding men with elevated levels of PSA we could improve early detection of prostate cancer and save lives.

Oh, the holes in this theory.

  • First, levels of PSA rise naturally over time. PSA levels are also naturally higher in African-American men, and in men whose prostate is just larger.
  • Second, elevated levels of PSA could also indicate a benign condition called BPH (benign prostatic hypertrophy–though it may not feel like it’s so benign if you have it).
  • Third, PSA levels don’t distinguish between an aggressive prostate cancer and one that’s growing more slowly.

The American Urological Association predicts that there will be 28,000 deaths from prostate cancer this year. But there’s a big difference between dying “from” prostate cancer and dying “with” prostate cancer. In the AUA’s view, if you died, and you had prostate cancer, you died “from” the disease. And it’s just not so.

Back in 2009 the man who developed a reliable test for PSA, Dr. Thomas Stamey, reversed his position based on the points above, and on the results of a large clinical trial that showed testing for PSA levels made no difference in overall death rates or the death rate from prostate cancer.Add to that the fact that treatment for prostate cancer can leave a man with a “poorer quality of life” (read: impotent), and the rationale for testing goes out the window.

Following that reversal, the US Preventive Services Task Force (not part of the US Government) made final recommendations, giving a D grade to evidence for testing PSA levels. Then in 2013 came revised AUA recommendations for annual PSA testing, which said:

  • Under age 40, no screening;
  • Ages 40-54, no testing for men of average risk;
  • Ages 55-69, regular testing only if you’re at higher risk (say, a family history of prostate cancer); and
  • In men age 70 and up the potential for harm outweighed the benefits, so no testing at all for them.

Now, if you have prostate symptoms, then by all means get tested. Pain or blood on urination, difficulty passing urine, and incomplete emptying of the bladder are all indications that something is going on with your prostate. Even there it’s not the cancer that’s causing problems, though. Instead, it’s that something is causing the prostate to block the passage of urine through the urethra. It could be from a tumor, or from swelling due to BPH. Nevertheless, get checked.

But for you men with ordinary risk levels, and no prostate symptoms, skip the blood test.


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