Useless Medicine: PSA Testing

by Dr. Julian Whitaker
Filed Under: Useless Medicine
Last Reviewed 02/17/2014

Useless Medicine: PSA Testing

Prostate-specific antigen (PSA) is an enzyme produced in the prostate. For decades, men older than 50 have been recommended to have their blood level of PSA tested annually. If it’s higher than 4 ng/mL, they’re usually urged to have a biopsy or other evaluation.

If routine PSA testing were helping men, I would be all for them. But research shows that it’s not and, in many cases, does more harm than good.

Routine PSA Testing Leads to Overdiagnosis, Not Fewer Deaths

In a multicenter study published in the New England Journal of Medicine, researchers compared the outcomes of more than 76,000 men, ages 55 through 74, who were randomly assigned to have annual PSA testing plus digital rectal exams or “usual care.”

After seven years of follow-up, there was a 22 percent increase in prostate cancer diagnosis in the screening group compared to the control, but no difference in the death rate from this disease. PSA testing clearly did not save lives.

A second study published in the same journal, involving 182,000 men of similar ages, emphasized the risks of overdiagnosis—and reported that it may be as high as 50 percent. If not for PSA testing, these men would never have symptoms or be aware that they had cancer.

In other words, all too often prostates are yanked out, testosterone levels are decimated and quality of life is destroyed for nothing!

Other Downsides of Routine PSA Testing

A high PSA level also doesn’t automatically mean you have prostate cancer. Infection, age-related prostate enlargement, even sex the night before the blood draw can raise PSA levels.

Furthermore, 4 ng/mL is no magic number. Stanford University researchers conducted a study in which they compared preoperative PSA scores with postoperative tumor size and found that a PSA of 9 was no more predictive of a large, aggressive tumor than a score of 2.

You’d think that because PSA values are an unreliable indicator of cancer, let alone tumor size and severity, physicians would proceed cautiously, order repeat tests, monitor patients and take action only if levels continue to increase.

This treatment philosophy, called “watchful waiting,” is the most reasonable approach and a cornerstone of the program I recommend to my own patients.

But that’s not what happens. Overdiagnosis leads to overtreatment and overtreatment causes harm. Some of the most horrific adverse effects associated with conventional treatments include increased risk of impotence, urinary incontinence, bowel dysfunction and even death.

Latest Guidelines for PSA Testing Also Acknowledge Harm

I’ve been presenting solid scientific evidence showing that routine PSA testing does more harm than good for decades. Now a conservative panel of mainstream medical experts is supporting my position, as well.

In October 2011, the United States Preventive Services Task Force (USPSTF) issued new draft guidelines regarding PSA testing for prostate cancer for men of all ages. They graded this test with a D: “The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.”

The USPSTF reviewed all the available research involving hundreds of thousands of men and concluded, “The common perception that PSA-based early detection of prostate cancer prolongs lives is not supported by the scientific evidence.”

The Bottom Line: Don’t Get PSA Tests

Will these well-researched, medically sound guidelines change clinical practice? Probably not. But you should take this recommendation about PSA testing seriously.

Despite a huge increase in diagnoses and treatment, the prostate cancer death rate has not dropped significantly—proof that many of the cancers treated are small, localized tumors that, if left alone, would never cause illness, let alone death.

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