NO to routine screening of prostate cancer with PSA

Men who have a first-degree relative (a father or brother) with prostate cancer are more likely to develop the disease. Men with female relatives with breast cancer related to the breast cancer gene (BRCA) may also be more likely to develop prostate cancer.
 
I didn’t know that, and this led me to start reading about PSA screening. I have never been a huge fan, because I knew that a large majority of cancers diagnosed by this method wouldn't have been symptomatic, and have given no trouble to men.

However, as I started reading, the more confused I became. I decided to do this post in two parts, first the NOT in favor of PSA screening, the following in favor of PSA screening.

Those not in favor of PSA screening:
▪ The United States Preventive Services Task Force recommends against PSA screening to detect prostate cancer
▪ The American Cancer Society, the American Urological Association and many European cancer societies recommend that men considering having prostate cancer screening first discuss the risks and benefits with a healthcare provider.

This are the recommendations from the American Urological Association:

• PSA screening in men under age 40 years is not recommended.
• Routine screening in men between ages 40 to 54 years at average risk is not recommended.
• For men ages 55 to 69 years, the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, shared decision-making is recommended for men age 55 to 69 years that are considering PSA screening, and proceeding based on patients’ values and preferences.
• To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce over diagnosis and false positives. 
• Routine PSA screening is not recommended in men over age 70 or any man with less than a 10-15 year life expectancy.

Many prostate cancers detected with screening are unlikely to cause death or disability.

Thus, a number of men will be diagnosed with cancer and potentially suffer the side effects of cancer treatment for cancers that never would have been found without prostate cancer screening. 

What are the side effects of treating prostate cancer, the most common are:

. Sexual dysfunction
. Urine incontinence
. Bowel dysfunction

And many times, screening finds cancer that would have never given any symptoms, which would have never required treatment.

In other words, even if screening finds a cancer early, it is not clear in all cases that the cancer must be treated.

In conclusion:
. PSA has a lot of false positives, 75% of patients that had positive PSA in a large European study had negative biopsies!
. Early treatment has not been proven to lead to less people dying of this cancer! (American study)
. Thus, the only benefit from my point of view seems to be that you KNOW you have cancer…..and that is a benefit? I don’t know…..

But there are people that have a different point of view and say: YES to screening: I’ll talk about this in my next post.