Why I Won’t Get a PSA Test for Prostate Cancer – By John Horgan on June 14, 2017


Physicians are still recommending the blood test for prostate cancer even though it harms far more men than it helps

If you get a PSA test for prostate cancer (visible in top right corner of this micrograph), you are 80-40 times more likely to get unnecessary surgery or radiation than you are to have your life saved, according to the U.S. Preventive Services Task Force. Credit: Nephron Wikimedia (CC BY-SA 3.0)

I recently had an awkward conversation with my doctor. I was getting a routine physical, and he recommended that I get a PSA test for prostate cancer. I’m 63.

I told him the PSA test harms more men than it helps. He acknowledged that PSA tests produce false positives, but he insisted that follow-up tests and biopsies will determine whether you really have a life-threatening cancer. He knew someone whose life had just been saved by the test.

When I still declined to get tested, he looked as though he felt sorry for me. He should feel sorry for the millions of men who have gotten unnecessary biopsies, surgery and radiation as a result of taking the PSA test.

PSA stands for prostate-specific antigen, an enzyme produced by the prostate gland, which is located below the male bladder. The test, which was developed in the 1980s, looks for elevated PSA levels, which can indicate cancerous cells in the prostate gland.

The problem is that inflammation and other problems unrelated to cancer can also elevate PSA levels. And when the PSA test correctly detects cancer, it is often so slow-growing that it would never have caused death or even impairment of health. Detection of these non-deadly cancers is called overdiagnosis.

In 2012, the U.S. Preventive Services Task Force, a federally funded panel of experts, recommended against the PSA test, saying the cons outweighed the pros. The decision was based primarily on data from two large studies, one done in the U.S.,which found that screening did not reduce mortality, and the other in Europe, which showed a modest reduction.

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