Concerning Trends in PSA Testing: One Expert’s Take

Two studies from JAMA, the Journal of the American Medical Association, report that fewer men are being screened for prostate cancer. These findings are concerning, says James Mohler, MD, Chair of the Department of Urology at Roswell Park and also Chair of the National Comprehensive Cancer Network’s Prostate Cancer Guidelines Committee, particularly since they also noted a pronounced decrease in the numbers of men being diagnosed with early-stage prostate cancers.

“Early detection means that you find prostate cancer only in men who would be likely to die from an undiagnosed prostate cancer,” notes Dr. Mohler. “If you detect prostate cancer early in this group and treat them appropriately, the 40% mortality decrease from prostate cancer achieved since 1992 can be maintained without overtreatment. Unfortunately, overtreatment begins with overdiagnosis. Indiscriminate PSA testing of too many men, prostate biopsy in anyone with even a small PSA elevation and overuse of radiation are documented problems that must be addressed.

“Just as dangerous to men’s health, however, would be to respond to these issues by not testing any men for prostate cancer unless they have symptoms of the disease. Because symptoms occur only when prostate cancer has advanced to the point where it can no longer be cured, that would condemn some men, and especially those at high risk, to death from prostate cancer. PSA testing should be personalized and used more frequently in men who are African American, have brothers or fathers who have been diagnosed with prostate cancer, or have BRAC mutations or Agent Orange exposure.”

Roswell Park did not participate in the JAMA studies. Those studies and an accompanying editorial:

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