Why is the PSA Test to Detect Cancer in Men Controversial?


The medical community has been diligent about stressing the importance of early-detection screenings for breast cancer, cervical cancer and colon cancer. So why is the prostate antigen test (PSA test), designed to help detect prostate cancer in men, the subject of such controversy?     


During the kick-off of USMD Hospital at Arlington’s Man Series of free health lectures, Rich Bevans-Thomas, M.D., a specialist in the treatment for prostate cancer and member of USMD Prostate Cancer Center, explained why the simple blood test that measures the level of PSA in a man’s bloodstream is coming under fire.


“Although the PSA test is a very good test, we can’t rely on it 100 percent,” Dr. Bevans-Thomas explains. “We must also do a digital rectal exam. If I feel a nodule on the prostate during the rectal exam, it could be a cancerous growth. The only way to know if you have prostate cancer is to have a biopsy and to look at the cells under a microscope.”


PSA levels measuring less than 2.5 are considered within the normal range. But of the men who have a PSA level of 2.5, biopsies confirm prostate cancer in approximately 21 to 23 percent. For men with a PSA level of 4.0, roughly 27 to 29 percent are diagnosed with prostate cancer.  An initial PSA test provides men and their doctors with a baseline PSA level. A follow-up test every year, allows physicians to monitor the rise in a patient’s PSA velocity over time—an important warning sign for prostate cancer in men.


“Prostate cancer continues to be a lethal disease that nearly 30,000 men will die from every year,” Dr. Bevans-Thomas says. “If we don’t do a PSA test or digital rectal exam, there is no way to know if you have cancer until you are metastatic. At that point, we can find cancer, but it’s too late. Treatment for prostate cancer won’t help.”


So who is suggesting men should forgo an annual PSA test even though it has reduced prostate cancer deaths by 44 percent since it was introduced in 1991? The United States Preventative Task Force (USPTF)—a group of primary care physicians charged with developing recommendations about which preventative health screenings should be covered by the Affordable Health Care Act.


Recently, the USPTF gave the PSA test a “D” rating based on two studies—one in the United States and one in Europe—that followed prostate cancer in men. Number crunchers for both studies suggested that too many men had to be treated in order to prevent one death. In the U.S. study, 10 men had to be treated to prevent one death, while in the European study 37 men were treated to prevent one death. But as critics have pointed out, both studies are flawed due to irregularities in the control groups. Although men in the control groups were not supposed to have ever had a PSA screening, many actually had received one or more PSA tests during their lifetime—thus, invalidating the results from both studies.


The USPTF based its “D” rating on other reasons, too—citing PSA anxiety, the risks associated with biopsies, the high percentage of men who proceed with treatment for prostate cancer (radiation, surgery and ablation), and the potential side effects (incontinence, erectile dysfunction) that can accompany treatment.


“It is an imperfect test,” Dr. Bevans-Thomas admits. “But the bottom line, as one of my professors at M.D. Anderson said, ‘Death is a binary issue.’ We cannot cure patients with advanced disease, and I’m seeing more PSA levels of 100 than I have in quite some time. Prostate cancer in men is going up because the baby boomers are growing older. If I see a patient who is complaining of back pain and he has a PSA of 150, the cancer is already in his bones.”


PSA tests are still the best way to identify individuals who may be at risk for prostate cancer (the number two killer of men, right behind lung cancer) and catch it early when treatment for prostate cancer can be effective. Regardless of the USPTF ranking, PSA tests have been integral in reducing deaths from prostate cancer by up to 44 percent—reason enough for men to have a PSA test on an annual basis. To schedule your PSA test at USMD Prostate Cancer Center, please call 1-888-PROSTATE (1-888-776-7828).

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