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One of the most controversial issues in men’s health is whether men should routinely have a blood test for prostate-specific antigen (PSA) to screen for prostate cancer. Some experts argue that PSA testing saves lives by early detection. Others say it triggers unnecessary treatment that disrupts more lives than it saves, causing life-changing side effects such as incontinence and erectile dysfunction. The results of 2 new studies focused on the debate, but scientists are still a long way from concluding the discussion, reports the Harvard Men’s Health Watch.
The crux of the controversy is whether screening for prostate cancer using the PSA test does more harm than good. The new studies—one in the United States, the other in Europe—were designed to answer this. Half of the volunteers in both studies were randomly as-signed to have PSA tests, while the other half simply received their usual medical care. In the studies, men with high PSA levels (above 4.0 ng/mL in the Americans and 3.0 ng/mL in the Europeans) underwent prostate biopsies to look for cancer. The American study found that after 7 and 10 years, PSA screening increased the diagnosis of prostate cancer, but did not improve survival. After 9 years, the European study found that men who had been screened were less likely to have died of prostate cancer, but at a substantial cost of overdiagnosis and overtreatment.
PSA testing remains a personal decision. Skeptics said there was no evidence that PSA screening saves lives. These studies now support that view. Until now, the default recommendation for undecided pa-tients was in favor of testing. These studies suggest the opposite strategy might be better—that unless a man has a particular reason to request a test, the default should be to skip it.
(Source: Harvard Men’s Health Watch, Harvard Health Publications, July 2009)
