PSA for Prostate Cancer Screening? Yes. No. Yes. Maybe.

puzzled man
What You Need to Know: Mortality in prostate cancer is lower in areas with frequent use of PSA testing compared with areas with little testing shows a new study. Results from the study show that prostate cancer mortality was 20 percent lower in counties with the highest incidence of prostate cancer, which indicates an early and rapid uptake of PSA testing.
The Evidence: The study is based on data from nation-wide, population-based registers in Sweden including the Cancer Register, The Cause of Death Register and the National Prostate Cancer Register (NPCR) of Sweden.

“Our results show that prostate cancer mortality was 20 percent lower in counties with the highest incidence of prostate cancer, indicating an early and rapid uptake of PSA testing, compared with counties with a slow and late increase in PSA testing,” says Pär Stattin, lead investigator of the study. “Since the difference in the number of men diagnosed with prostate cancer is related to how many men undergo PSA testing, we think our data shows that PSA testing and early treatment is related to a modest decrease in risk of prostate cancer death,” says Håkan Jonsson statistician and senior author of the study.

“In contrast to screening in randomized studies our data is based on unorganized, real life PSA testing. We therefore used a statistical method that excludes men that were diagnosed prior to the introduction of PSA testing since these men could not benefit from the effect of PSA testing,” continues Håkan Jonsson.

“The results in our study are very similar to those obtained in a large European randomized clinical study (ERSPC) thus confirming the effect of PSA testing on the risk of prostate cancer death. However, we have to bear in mind that the decrease in mortality is offset by overtreatment and side effects from early treatment. PSA testing sharply increases the risk of overtreatment, i.e. early treatment of cancers that would never have surfaced clinically. We also know that after surgery for prostate cancer most men have decreased erectile function and that a small group of men suffer from urinary incontinence. Our data pinpoints the need for refined methods for PSA testing and improved prostate cancer treatment strategies,” concludes dr Stattin.

My Take: The role of PSA as a screening tool remains unclear. My take is that it leads to overtreatment, but that this is more an issue of how we use the test, rather than the test itself. PSA testing is the best means that we now have available to identify those patients who have prostate cancer.  After a prostate biopsy is done, and if the biopsy identifies cancer, a patient must decide whether to treat the disease or to undergo active surveillance. To make such a decision, the patient needs to be completely informed of their disease status. So have a chat with your health care provider to see if the PSA makes sense for you. Clearly, not everyone benefits from PSA. Still, I think PSA does diminish the risk of death, especially among higher risk populations such as African American men. So don’t ignore PSA testing: Have a dialog with a valued health professional to see if it is appropriate for you. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.


Umeå universitet. “PSA testing, early treatment decreases risk of prostate cancer death.” ScienceDaily. ScienceDaily, 10 March 2014.

P. Stattin, S. Carlsson, B. Holmstrom, A. Vickers, J. Hugosson, H. Lilja, H. Jonsson. Prostate Cancer Mortality in Areas With High and Low Prostate Cancer Incidence. JNCI Journal of the National Cancer Institute, 2014; DOI: 10.1093/jnci/dju007

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Harvard AB Yale MD UPenn Radiation Oncology Radiation Oncologist, Seattle area

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