It’s time to stop getting that PSA test for prostate cancer

I was reminded of this when I learned of a new article “hot off the press”, published in the Journal of the National Cancer Institute. The news was so exciting that they published the results online before the journal was released. And what was so exciting? We learned that screening for prostate cancer doesn’t save any lives.

The study described in the article was the Prostate, Lung, Colorectal, and Ovarian Screening trial (PLCO). I already wrote about the Lung cancer part of the trial (CT scanning), which worked; CT scanning saved lives. But the Prostate cancer trial (PSA testing and rectal exam) did not.

Here is how the trial was done. Men were randomly assigned to either screening with yearly PSA testing (Prostate Specific Antigen – found in the blood and goes up if there is prostate cancer) and rectal exam to feel for nodules in the prostate gland, or just routine care. Now the routine care may or may not have included the prostate cancer screening. It wasn’t supposed to, but who knows? There were about 37,500 men, 55-74 years old, in each arm of the study.

At the time this paper was written, 3815 cancers were found in the usual care group and 4250 in the men that were tested. There were very few deaths in either group. In the screened group 158 men died of prostate cancer, while there only 145 prostate cancer deaths in the men who weren’t being routinely tested. No significant difference. Perhaps the most convincing evidence that screening doesn’t work is that the lead author of the paper is a urologist, a surgeon who operates on prostate cancer. Urologists are the only national group that still recommends screening.

All this work echoes another article published last year in the British Medical Journal summarizing all the studies on screening for prostate cancer. This one included trial of nearly 400,000 patients, some of which were in the PLCO study. This paper also found that screening did not save lives.

Maybe there isn’t a clear-cut benefit. What’s the downside to screening? The treatment. Surgery, radiation, and drugs can cause sexual difficulties, urinary problems and in general, not a happy life. And if you are diagnosed with prostate cancer, even if your doctor says it is low grade and doesn’t need surgery, this is hard for most men to live with and they eventually will opt for treatment and take their chances with the side effects.

Screening should save lives. If it doesn’t, then it isn’t worthwhile. This is especially true in prostate cancer where the side of effects of the treatment can be devastating.

So do as I do say (and do), stop taking the test.