The perils of PSA Prostate Cancer Screening

We will discuss cancer screening in the next two segments, but will start with the PSA.  Why this test?  Because it is the poster child of what is wrong with screening.  One third of men develop prostate cancer in their lives, but few die of it.  The 10 year death rate is 1% and the 15 year death rate is 3%.  Because these cancers move slowly, and because the few that are lethal will kill you whether you are treated or not, treatment doesn't change those numbers.  Yes, if you have prostate cancer you will have a 1% risk of dying in 10 years whether you are treated or not.  And the treatment is toxic; it causes impotence, incontinence, a reduction in masculinity, and other potentially severe complications.  It will lower your PSA and give you the illusion of cure, but it doesn't actually help you.  So, yes, we can screen you for prostate cancer with a PSA, we can provide toxic treatment and harm you all in the name of lowering that PSA, but you won't live a day longer.  You will only be sicker.  Studies have shown that merely getting a PSA can shorten your life.  But it's big business, it earns tens of billions of dollars (perhaps even hundreds of billions when you look at downstream costs) for doctors, radiation centers, hospitals, and drug companies.  That's why when the US Preventive Service task force gave PSA testing an F, meaning it causes more harm than good, the urology society and radiation oncology society lobbied congress and forced them to change the grade to a C, may cause more harm.  So, learning about PSA and its perils and deceptions is a good way to start!

"The greater the ignorance, the greater the dogmatism." -William Osler, MD

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