The pros and cons of PSA tests for prostate cancer for midlife and older men

A humor trial called a PSA tin thief surface men for prostate crab but it tin besides lead to unnecessary treatment. miodrag ignjatovic/E+/Getty Images hide caption

toggle caption

miodrag ignjatovic/E+/Getty Images

News that erstwhile President Joseph Biden has advanced prostate cancer has revived long-standing questions astir nan benefits versus nan harms of a humor trial that screens for nan most commonly diagnosed crab among men successful nan U.S.

Prostate-specific antigen, aliases PSA, screening tests are an imperfect instrumentality for detecting prostate cancer, doctors and nationalist wellness experts say.

Part of nan problem is identifying and treating fierce cancers for illustration Biden's while not unnecessarily treating men pinch slow-growing cancers improbable to sicken them. Autopsies found nan illness to beryllium truthful wide that much than one-third of achromatic men and half of Black men successful their 70s had prostate cancers that would ne'er do immoderate harm.

"PSA testing unsocial leaves a batch to beryllium desired arsenic a crab screening test," said radiation oncologist Dr. Brent Rose, an subordinate professor astatine nan University of California, San Diego, School of Medicine.

The trial measures nan level of PSA, a macromolecule produced by normal arsenic good arsenic malignant prostate gland cells, successful nan blood. Elevated PSA tin beryllium a marker for cancer. It besides tin awesome a mendacious affirmative aliases an inactive cancer, triggering a achy biopsy, and starring to overtreatment pinch punishing broadside effects, including impotence, incontinence and bowel dysfunction.

"PSA screening is beneficial," Rose said. "There are risks, though, and truthful it is simply a individual determination whether aliases not to do PSA screening."

The cardinal is to target and dainty fierce cancers while waiting and watching cancers that mightiness ne'er go troublesome, Rose and different oncologists told NPR. Physicians person been stepping this tightrope since they began regularly utilizing PSA tests to surface for prostate crab successful patient men successful nan 1990s. There is nary different trial that efficaciously screens for prostate crab — nan second deadliest cancer for American men, oncologists said.

A history of conflicting guidance

Attempts to equilibrium nan imaginable harms against nan number of lives saved person led to two decades of fluctuating – and confusing – nationalist wellness guidelines connected PSA screening. In 2012, nan U.S. Preventive Services Task Force advised against immoderate screening, only to rumor a watered-down proposal successful 2018 that men ages 55 to 69 talk screening pinch their wellness attraction providers. Various physicians' groups connection conflicting guidance for this property group.

In its proposal to older men, however, nan U.S. Preventive Services Task Force has been somewhat much consistent. In 2008, nan independent sheet of nationalist experts recommended men 75 and older not beryllium screened, and since 2018, nan sheet has advised against screening men 70 and older.

Biden, 82, apparently followed nan guidance. He past had a PSA screening trial successful 2014, erstwhile he was 71 aliases 72 years old, a spokesman said.

For men betwixt nan ages of 55 and 69, nan task unit recommends talking to their wellness attraction providers astir their preferences earlier deciding whether to get a PSA test. It classifies nan proposal arsenic Grade C, which intends it offers only a mini use and insurers whitethorn not screen it.

Finding nan clip to person a speech astir a taxable arsenic analyzable arsenic nan worth of prostate-cancer screening tin beryllium challenging for astir primary-care physicians, oncologists interviewed for this communicative said. And while immoderate men mightiness invited what's called "shared decision-making," others find it agonizing. Still, nan only proposal for men for now is to talk nan rumor complete cautiously pinch their doctors.

The lawsuit for nan PSA test

Dr. Alicia Morgans, a genitourinary aesculapian oncologist astatine nan Dana-Farber Cancer Institute successful Boston, recognizes nan problem and hopes that nan task unit will reside it successful caller guidelines, which it is presently drafting. In August, she met pinch nan unpaid sheet successful her domiciled arsenic chair of nan aesculapian advisory committee for nan defense group Zero Prostate Cancer.

Morgans believes nan existent guidance was based connected a flawed objective trial. It concluded that men screened pinch PSA tests were nary little apt to dice of prostate crab than men assigned to a group that was not screened. But nan results were muddied because astir 90% of nan men successful nan power group had astatine slightest 1 PSA trial earlier aliases during nan trial, she said.

Morgans would for illustration to spot nan proposal beefed up truthful much men get screened for prostate crab and Black men and men pinch a family history, who are much vulnerable, get screened earlier.

"I return attraction of group who person very precocious prostate cancer, arsenic good arsenic immoderate group who person curable prostate cancer," she said, "so my position is really skewed by nan truth that I really want to make that test erstwhile things are curable."

So does Dr. Matthew Cooperberg, a urologic oncologist and a professor astatine nan University of California, San Francisco. He has pushed to rename early-stage prostate crab successful portion to easiness nan accent of a crab diagnosis. One imaginable name, "acinar neoplasm," describes an abnormal maturation but 1 lacking nan imaginable to dispersed aliases kill. Cooperberg besides advocates monitoring men pinch elevated PSAs earlier rushing to biopsy their prostates.

"Men should get PSA testing successful midlife pinch nan extremity of uncovering fierce prostate cancer," he said. "If we find low-grade illness on nan way, whether aliases not we telephone it cancer, we should not dainty it. We conscionable show it pinch progressive surveillance. If we do that, we tin erase this cancer."

A caller attack to prostate crab screening emerges

Dr. Tyler Seibert, a radiation oncologist and subordinate professor astatine nan University of California, San Diego, is not arsenic optimistic astir eliminating prostate cancer. But he excessively is dedicated to uncovering ways to place nan bad prostate cancers and treating only them.

When doctors first began doing PSA screening tests, he said, "there was a flawed presumption that was implicit that if you find immoderate benignant of prostate cancer, you must dainty that benignant of prostate crab aggressively," he said. "Many of them would ne'er person harmed nan patient."

A caller era successful prostate-cancer screening has arrived, Seibert believes. Today, alternatively of men instantly having their prostates biopsied erstwhile they get an elevated PSA test, he and an expanding number of prostate-cancer specialists urge first getting an MRI and, erstwhile possible, watching and waiting.

"For these patients pinch low-risk prostate cancer, we person really beardown grounds that we tin travel them closely, and they fundamentally tin conscionable transportation connected pinch their life," he said.

Not everyone is comfortable pinch getting periodic humor tests to spot if their PSA mightiness beryllium rising and they mightiness so request crab treatment, Seibert acknowledged. But astir of his patients do go comfortable pinch nan protocol, he said.

"Every clip you get that humor test, you're benignant of a small spot nervous," he said. "If you tin tolerate that, and you don't deliberation that it's going to beryllium causing you excessively overmuch anxiety, past screening makes a batch of sense."

Ronnie Cohen is freelance wellness journalist based successful nan San Francisco Bay Area.