December 12, 2017
On PSA and Screening
Be Well

On PSA and Screening

by John Swartzberg, M.D.  |  

You may still be confused about Prostate Specific Antigen (PSA) screening for prostate cancer and whether you (or, if you’re a woman, the men you care about) should be tested. I still debate about it in my head, and with my own doctor.

My doctor, an internist, remains convinced that screening can save the lives of at least a small number of men. We have had several conversations about this, and I’ve decided to trust her judgment for now, though the U.S. Preventive Services Task Force's report has added to my reservations. Should my numbers start to rise, I know I’ll be able to work with her to make good decisions (fingers crossed) about what to do—and what not to do.

Other male members of our Editorial Board are split about whether they will be screened. Two won’t, several are considering stopping, while the rest will continue to be tested, though some with ambivalence.

You should discuss all this with your doctor. Ultimately, it’s up to you how you want to play the odds, but it should be an informed decision. You may decide to be screened, for example, if you place greater value on finding cancer early, despite the uncertain benefits and known risks. In contrast, you may decide against it if you fear that getting abnormal PSA results will land you on the “slippery slope” of overdiagnosis and overtreatment, with all the potential harms that entails.

Many doctors include the PSA test in routine blood work without asking, or even telling, their patients. Some don’t mention the potential harms. If your doctor isn’t willing to discuss the pros and cons of testing with you, you might look for another doctor. The American Cancer Society and Centers for Disease Control and Prevention have decision aids to help men decide about prostate testing.

Research continues, and I hope that in the next few years there will be better tests and tools to judge which tumors are likely to advance. That would make PSA screening less controversial.