According to Dr. David Samadi, “Despite the efforts made in regards to early detection for prostate cancer, the disease remains the second leading cancer cause of death in men, killing approximately 27,500 men this year. Tens of thousands of additional men suffer from the burden of painful metastatic prostate cancer, which can lead to bone fractures, the inability to urinate, spinal cord compression and renal failure. The evidence remains that since PSA screening became widely recognized in the early 1990’s, there has been a 39 percent reduction in prostate cancer mortality rates.”
However, not everyone agrees with his finding. Others say that fewer PSA tests will not cause more prostate cancer deaths. According to Dr. Kenneth Lin, a family medicine physician at Georgetown University School of Medicine, the claim that fewer PSA tests will cause more prostate cancer deaths is based on “putting all your faith” on a European study that found a mortality benefit from PSA screening. Dr, Lin said “It’s not right to ignore the other trials,” which he claims did not show the PSA blood test saves men’s lives.
There has been controversy over PSA screening for a number of years. The evidence began piling up about a decade ago that the PSA test leads to overdiagnosis and overtreatment. It is true that an elevated PSA may indicate prostate cancer. However, the PSA is not specific for prostate cancer and could also indicate other prostate related conditions. Many argue that prostate cancers are so slow growing that they may never even put a man’s health or life at risk, and that many men with prostate cancer will die with it, not of it.
The PSA test is not perfect, and there are a few new blood tests being developed to replace the PSA test such as the 4KScore and the PHI test, both of which are prostate cancer. In the meantime, rather than getting rid of PSA screening, there are other things that can be done to optimize the benefit of the PSA test while reducing overdiagnosis and overtreatment. It is important that that PSA test not be looked at as a single test result. Physicians must also take into account the PSA trends, co-morbid conditions, overall life expectancy, and understand patients’ treatment goals.
According to Dr. Samadi, “The controversy over PSA screening exposes the importance of the need for physicians to put more emphasis on treating their patients as individuals, and not just as a population. Because the PSA test is not always the best measurement for all patients, the decisions made for diagnosing and treating each patient should be based on the individual. Until then, and until we have a better test for diagnosis prostate cancer, it is simply too dangerous to tell men to stop having PSA tests.”