PSA testing has become more and more controversial over time. Back in the 1990’s, when it was invented, it was hailed as a panacea; the first legitimate blood test to screen for a common cancer. At that time, in an unscreening population, the test appeared to be very accurate and allowed me to diagnosis several early-stage prostate cancers that would otherwise have been missed. Many men benefited from the early diagnosis and treatment.
Now, though, the population has been screened extensively and thus the demographics have changed. The benefits of PSA screening in a highly screened population seems to be less and less, and the negatives of testing have become greater.
With this, the US Prevent Health Services recently came out with recommendations against routine PSA screening, based on the negative impact of invasive testing on many men with elevated PSA’s and no signs of cancer.
Although this is now the current recommendation, not to screen, I will tell you that generally we will continue to do this test on a routine basis with the following caveats:
1. A negative (or very low) PSA is a virtual guarantee that there is no prostate cancer present. I’m 100% convinced of this based on my past 20 years of experience. I have had zero cases of prostate cancer in patients with low PSA’s.
2. An elevated PSA does not diagnose ‘prostate cancer’ but rather it provides some important information on the potential for prostate cancer and can be used in conjunction with other information (including future and past PSA’s) to determine the potential for cancer.
3. The PSA is a ‘double check’ for the prostate exam and provides reassurance if there are any questions at all about the normalcy of the prostate when checked at the time of the physical.
So….despite the current recommendations, I think you will see the ongoing widespread use of the PSA, but with a tempered approach to it’s interpretation.