Screening for Prostate Cancer using PSA: Is it recommended?

What is PSA test?

PSA stands for prostate specific antigen. This protein can be detected in the blood using a simple blood test. High levels could suggest the presence of prostate cancer, and therefore the test has been used to screen men for this cancer. (Screening is done to check for the presence of an illness in a person who do not have any symptoms so that the condition can be diagnosed and treated early.) However, there are benign conditions that could also result in a rise of PSA levels; therefore the test does not confirm the presence of the cancer.

The PSA test has a few advantages when used as a screening test. The patient has to undergo a blood test, in contrast to other tests for prostate cancer like prostate biopsy. The cancer, if detected early, can be completely cured.

There are also several disadvantages of doing the PSA test. Since there are other benign conditions that could also result in a rise in PSA, the test has a high chance of false positive results which could subject the patient to a lot of anxiety. In addition, the patient may have to undergo further tests like prostate biopsy, which may turn out to be quite unnecessary and put the patient at a risk of suffering from complications from the procedures. It may also result in diagnosis of cancers that may never have caused death in the patient.

Recommendations Regarding PSA Screening:

The US Preventative Services Task Force (USPSTF) and the American Academy of Family Physicians (AAFP) recommend against using PSA testing as a screening test for prostate cancer.

The American Urological Association (AUA) does not recommend routine screening with PSA in men below the age of 55 years, unless they are at higher risk for prostate cancer, in which case the decision should be individualized. Men between the ages of 55 and 69 years would probably benefit the most from the screening, and therefore the test can be discussed with the patient. The test may be repeated once in two years in these patients, instead of annually, to reduce the chances of false positive results. Screening is not recommended in those with a life expectancy of less than 10 to 15 years.

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The American College of Physicians (ACP) recommends that men between the ages of 55 and 69 should be informed about the limited potential benefits and substantial possible harms of doing PSA testing. The decision to do the test should be based on the risk of the individual patient, result of the discussion, patient’s preference and the general health and life expectancy of the patient.

Thus, routine screening for all men with PSA test is not recommended. Another test that could be more accurate could possibly fill this gap in medical science in the future.

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Reference:

1. http://www.auanet.org/education/guidelines/prostate-cancer-detection.cfm

2. http://www.uspreventiveservicestaskforce.org/prostatecancerscreening.htm

3. http://www.aafp.org/patient-care/clinical-recommendations/all/prostate-cancer.html

4. Amir Qaseem et al. Screening for Prostate Cancer: A Guidance Statement from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. 2013;158(10):761-769.

Source-Medindia