Prostate cancer is a growing concern among men around the world. It is estimated that approximately 248,530 men in the United States will be diagnosed with prostate cancer in 2021, and about 34,130 men will die from the disease.

To detect prostate cancer, men are often recommended to undergo a prostate-specific antigen (PSA) test. However, there has been controversy regarding the effectiveness and potential harms of PSA testing. This article will explore the benefits and drawbacks of PSA testing as a prostate cancer screening tool.

What is PSA testing?

PSA is a protein produced by cells in the prostate gland. When the prostate gland is healthy, it produces a small amount of PSA, but the amount increases when there is inflammation or cancer present.

PSA testing measures the amount of PSA in a man’s blood to screen for prostate cancer.

The benefits of PSA testing

The advantage of PSA testing is that it can detect prostate cancer at an early stage before any symptoms occur. Early detection of prostate cancer can lead to better treatment outcomes and increase a man’s chances of survival.

In addition, PSA testing may be useful in monitoring men with a history of prostate cancer or those who are receiving treatment for the disease.

The drawbacks of PSA testing

The main disadvantage of PSA testing is that it can give false positives and false negatives. A false-positive result occurs when the test indicates the presence of cancer when there is none.

This can lead to unnecessary biopsies and treatment, which can cause anxiety and side effects. On the other hand, a false-negative result occurs when the test indicates the absence of cancer when there is cancer present. This can lead to delayed diagnosis and treatment, which can compromise a man’s chances of survival.

In addition, PSA testing has been criticized for leading to overdiagnosis and overtreatment of prostate cancer.

Overdiagnosis occurs when prostate cancer is detected and treated, but the cancer would not have caused harm or symptoms during the man’s lifetime. Overtreatment refers to the unnecessary treatment of prostate cancer that would not have caused any health problems or shortened the man’s life. This can lead to side effects and complications such as impotence, incontinence, and bowel problems.

Another criticism of PSA testing is that it may not be effective in reducing prostate cancer mortality.

Studies have shown that PSA testing can reduce the risk of dying from prostate cancer, but the reduction is small, and the benefits may not outweigh the harms of overdiagnosis and overtreatment.

Who should consider PSA testing?

The decision to undergo PSA testing should be an individual one and should be based on a man’s personal preferences, values, and overall health.

The US Preventive Services Task Force recommends against routine PSA screening for men aged 55 to 69, but suggests that men who are at increased risk of prostate cancer, such as African American men and men with a family history of the disease, should have a discussion with their healthcare provider about the potential benefits and harms of PSA testing.

Alternatives to PSA testing

There are alternative screening tools that can be used in lieu of PSA testing.

One such test is the digital rectal exam (DRE), which involves a healthcare provider inserting a gloved, lubricated finger into the rectum to feel for abnormalities or growths on the prostate gland. Another test is the prostate health index (phi), which measures PSA, free PSA, and a protein called p2PSA to provide a more accurate assessment of a man’s risk for prostate cancer.

The bottom line

Prostate cancer screening is a complex issue, and the decision to undergo PSA testing should be an individual one based on a man’s values, preferences, overall health, and discussions with his healthcare provider.

Although PSA testing can detect prostate cancer early, it can also lead to overdiagnosis, overtreatment, false positives, and false negatives. Alternatives to PSA testing are available, and men should consider all screening options before making a decision.