Articles last year in the New England Journal of Medicine were among the latest to cast a shadow over prostate specific antigen (PSA) screening for prostate cancer. A NEJM editorial recommended that individual patients make their individual choice about PSA screening by consulting with their doctor.
One doctor put it this way: No one really knows what is the right thing to do.
Urologist Chris Schrepferman believes you’re better being tested.
“There’s no question that tens of thousands of men have had their lives saved by PSA screening, early detection, and treatment of prostate cancer. No question,” he says. “The debate is whether the cost of widespread screening and the risk of the treatment of what are called insignificant tumors outweigh the benefits. That’s really a public health debate.”
“The key concern is the safety level,” says primary care physician Dr. John Roberts ’83. “A recent study showed that you’re 48 times more likely to have a complication from the follow-up diagnostic tests and cancer treatment than you are to die of prostate cancer.
“If you’re over 75, they’re not recommending it.”
“You almost hate not to offer it,” says primary care physician Dr. Scott Douglas ’84. “You hate not to do it, because prostate cancer is so prevalent, and you don’t want somebody with prostate cancer to come back to you and say, ‘You know, I think I might have had a better outcome if you’d ordered that test.’”
“I think the flaw on PSA testing is how we interpret and use the test, rather than whether the test has real value,” Schrepferman says. “The art in this particular science is to decide who needs to be treated, not whether or not it is effective.
“I usually have my patients [who have elevated PSA levels] get two or three opinions, and not just act on the word ‘cancer.’”