Does PSA Testing Save Lives or Not?

A message about the value of PSA tests in healthy men creates problems that might have been avoided with a better choice of words.

According to an article by Gardiner Harris in the NYTimes, "Healthy men should no longer receive a P.S.A. blood test to screen for prostate cancer because the test does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence in many...."

The problematic word is "over all," and not because it should be a compound word (i.e., overall). It would have been better to say "...the test does not save lives when evaluated from a public health point of view.

The PSA test done in an individual man does a poor job of differentiating whether an abnormal result is due to malignant or benign disease. Many men with an elevated screening PSA are subsequently found NOT to have cancer after undergoing invasive evaluation. It's like the "TSA test" at airports that also suffers from a high false positive rate, flagging many travelers, almost all of whom are subsequently found to be harmless.

In addition, PSA-prompted biopsies that DO show cancer can't differentiate (1) cancers that are aggressive and life-threatening from (2) cancers that are indolent and would never have caused the patient any trouble. Consequently, many men with "harmless" cancer become survivors who are forced to deal with the stresses, changes and losses that can last a lifetime.

In my next post: What this means for Healthy Survivors 

Comments

[Jan Hasak]

Nothing is easy, is it? Tests that appear to be life-saving later become controversial and stress-provoking. I guess that's part of medical life.
Jan