Watch out: PSA testing yet again

A paper published a little while ago in Annals of Internal Medicine about PSA testing for prostate cancer (PC) garnered lots of glowing headlines because the researchers, who had re-analyzed several previous important studies on PSA testing, concluded that “PSA testing reduces the risk of dying from prostate cancer (PC)” by roughly 20 % or so, a contentious conclusion that runs counter to what lots of experts have been telling us for the last few years.

And if this conclusion is to be accepted at face-value, it argues in turn, many expert piped up, that all men should get regular PSA testing from around age 50 to at least age 70.

So now for the “Yes, but” rebuttal.

First, there is lots of debate about the accuracy of the numbers generated in this study with many statisticians arguing that the percentage of lives saved from dying from PC through regular PSA testing is substantially lower than 20 %.

But even if one accepts that that percentage is close to reality, since only 3 % or so of men eventually die from PC, the overall absolute number of men whose lives will be saved from this test is pretty small.

As well, relying solely on “lives saved” as the key determinant for whether or not a man should be tested is not a reliable enough index to justify routine PSA testing.

That’s because a huge number of for men who are routinely tested with PSA screening will be told they need biopsies to rule out PC, and although the majority don’t actually have PC (their PSA level was elevated for other reasons), many of them nonetheless suffer substantial numbers of serious infections (some life-threatening) as a result of the invasive biopsy testing, as well as subsequent impotence and incontinence, with a consequent huge negative impact on their quality of life for the rest of their lives.

As well, of those men who do actually have PC, the majority do not have the kind of cancer that either shortens or worsens their lives – the old adage that way more men die with prostate cancer, than of prostate cancer.

There is no formulaic answer for this problem – the best you can hope for is to educated yourself as best you can and then make a decision based on your history, your hopes, your fears, and your intuition.

And hey, good luck with that.