PSA controversy

The controversy around the use of PSA for screening for prostate cancer has existed since the utility of PSA was first discovered. No screening test is perfect.  A perfect screening test would identify everyone who has cancer and exclude everyone who does not in a way which is inexpensive and noninvasive way.With an elevated PSA, the patient is in the unfortunate position of having to undergo a biopsy to prove there is cancer. Many biopsies will end up being negative. Approximately 25% will end up being positive for cancer.

These positive biopsies then have to be discussed with the patient. Not every person with prostate cancer should have treatment. One out of six men will be diagnosed with the disease, but not everyone will die of the prostate cancer, even if left untreated.

However, if we examine the pre-PSA era, men routinely walked into a urologist's office with widespread, uncurable disease. Now, it is rare to find such a patient. Mortality has decreased.

While research continues on better screening methods, men with prostate cancer should talk to urologists and get other opinions from trusted medical professionals. Hiding or preventing access to a diagnosis seems heavy-handed...

This statement from the American Urological Association summarizes our official position.