Physicians Say PSA Testing for Prostate Cancer Should Be More Targeted

Jason Merrill

Oct. 14, 2010 – While prostate cancer is the most commonly diagnosed form of cancer, the most common way of screening for the disease is under question from many in the medical community.

Siteman Cancer Center urologist Gerald Andriole, MD, chief of urology at Washington University School of Medicine, says prostate-specific antigen (PSA) testing should be tailored to individual risk.

In a recent editorial in the Sept. 14 online edition of the British Medical Journal (BMJ), Andriole writes that young men at high risk for prostate cancer, such as those with a strong family history and higher baseline PSA concentrations, should be followed closely and also be considered for risk-reduction approaches, while elderly men and those with a low risk of disease could be tested less often, if at all.

For example, in a recent study published in the same online edition of BMJ, men at age 60 who had PSA levels below 2 were extremely unlikely to die of cancer; hence, they could potentially not undergo further testing. On the other hand, men with higher PSA levels at that age had rising chances of dying of prostate cancer. They could be screened more intensely and should consider modifying their risk through lifestyle modifications or medications.

Tailoring the intensity of screening in this way can reduce overdiagnosis and overtreatment of small cancers that are not life-threatening.

“If a man has PSA testing done on an annual basis, his chance of being diagnosed with prostate cancer is six to seven times greater than his chance of dying from it,” Andriole says. “And because PSA can be elevated with any inflammatory process and even with a benign enlarged prostate, known as BPH, many men without cancer undergo unnecessary biopsies of the prostate.”

Andriole says with mass screening for prostate cancer, there are winners and losers. “Some men clearly benefit from early detection and early treatment, but other men are losers. They are diagnosed with a cancer, undergo unnecessary treatment and have side effects, and they go through all the pain and anxiety associated with having cancer.”

That’s why the American Cancer Society recently changed its screening recommendations, encouraging men to talk with their doctor before getting screened, saying “men should discuss the uncertainties, risks and potential benefits of screening for prostate cancer before deciding whether to be tested.”

“Approaches such as these will hopefully make the next 20 years of PSA-based screening better than the first 20,” Andriole says.