DR. MOHLER: PSA test – Is ignorance bliss…and prudent?
Mohler’s Medication Maxims
Fact: Prostate cancer is an important cause of death in American men.
Fact: Prostate cancer screening with the PSA (prostatic specific antigen) blood test remains a very controversial issue for many men.
In the 1990s, PSA screening became a routine part of the annual exam for many men. At the same time, the number of cases of prostate cancer doubled, and the death rate from prostate cancer fell slightly.
In 2012, the United States Preventive Services Task Force (USPSTF) changed their recommendation for routine PSA screening in healthy men from “We don’t know” to “Don’t do it. The harms outweigh the benefits.” The USPSTF decision was based on looking at four large studies that I would summarize as follows:
1) PSA screening saves an occasional man’s life (and it’s a big deal if it is you or me).
2) Screening resulted in lots of false positive tests: The test looks positive, the man does not have prostate cancer, but he has to endure more blood tests or biopsies to prove there is no cancer.
3) Screening resulted in many cases of over diagnosis, where the man is found to have prostate cancer, but the cancer would never have caused any symptoms throughout his life. Once diagnosed, however, most American men opt to be treated and therein are exposed to the costs, anxiety and potential for incontinence and impotence. The studies reflect that 49 men diagnosed with prostate cancer using PSA testing have to be treated to save one life. Forty-eight of 49 men will reap no benefit from the treatment, but will be exposed to all the potential side effects.
Talk to your doctor about PSA testing. I will continue to exercise my option to be blissfully ignorant.
Dr. Mohler has practiced family medicine in Grand Junction for 38 years. He has a particular interest in pharmaceutical education. Phil works part-time for both Primary Care Partners and Rocky Mountain Health Plans. Email him at firstname.lastname@example.org.
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