Will Fewer PSA Screenings Lead To More Prostate Cancer Deaths?

Will Fewer PSA Screenings Lead To More Prostate Cancer Deaths?

Two recent studies revealed that fewer men are undergoing PSA tests, which raises the question: Will there be more men dying from prostate cancer in the future as a result?

In a 2015 news release, Dr. David Samadi, chairman of urology and chief of robotic surgery at Lenox Hill Hospital in New York, said that despite efforts to push for early detection, prostate cancer was still expected to cause 27,500 deaths in the U.S. in 2015 alone.

“Tens of thousands of additional men suffer from the burden of painful metastatic prostate cancer, which can lead to bone fractures, the inability to urinate, spinal cord compression and renal failure. The evidence remains that since PSA screening became widely recognized in the early 1990s, there has been a 39 percent reduction in prostate cancer mortality rates,” Samadi said in the release.

Still, not everyone agrees with Samadi’s findings, and some believe that fewer PSA tests will not lead to increased prostate cancer related deaths. Dr. Kenneth Lin, a family medicine physician at Georgetown University School of Medicine, said believing that less PSA testing will lead to more death,  is based on  “putting all your faith” on the results of one study that found a mortality benefit from PSA testing.

“It’s not right to ignore the other trials,” Dr Lin said, noting that non-cited studies reveal that PSA blood tests save men’s lives as well.

PSA testing for prostate cancer screening has been a subject of debate for many years. A decade ago, evidence began revealing that PSA screening led to over-diagnosis and over-treatment. Elevated blood PSA levels in the blood can be indicative of prostate cancer but the marker is not specific and can be indicative of other prostate related conditions.

The 4KScore and the PHI test are two new screening methods being developed to replace the PSA test, and both are able to detect prostate cancer. Before these tests become available to replace PSA screening, other strategies can be employed to optimize PSA testing while reducing over-diagnosis and over-treatment.

Samandi contends that PSA screening results, overall life expectancy and co-existing conditions, should all be concidered in order to understand patients’ treatment goals.

“The controversy over PSA screening exposes the importance of the need for physicians to put more emphasis on treating their patients as individuals, and not just as a population. Because the PSA test is not always the best measurement for all patients, the decisions made for diagnosing and treating each patient should be based on the individual. Until then, and until we have a better test for diagnosis prostate cancer, it is simply too dangerous to tell men to stop having PSA tests,” Samadi said.

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Daniela holds a PhD in Clinical Psychology from The University of Edinburgh, United Kingdom, a MSc in Health Psychology and a BSc in Clinical Psychology. Her work has been focused on vulnerability to psychopathology and early identification and intervention in psychosis.

One comment

  1. Chris O'Neill says:

    “The evidence remains that since PSA screening became widely recognized in the early 1990s, there has been a 39 percent reduction in prostate cancer mortality rates,” Samadi said in the release.”

    This is not evidence that PSA screening saves lives or even lives from prostate cancer mortality. Observational correlation is not proof of cause. There can be many reasons for change in prostate death rate over time. The only way to prove cause is with a controlled trial, and none of the controlled trials have shown any overall survival benefit from PSA screening compared with usual care.

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