Prostate cancer: To screen or not to screen?

For the past 25 years, a prostate cancer screening test called Prostate-Specific Antigen (PSA) has offered the hope of reducing deaths from prostate cancer by catching the disease early when cure is possible. But recent findings have raised concerns over whether the test’s potential to save some men’s lives is worth the side effects from unnecessary treatments it leads to in many men.

Lorelei Mucci, associate professor of epidemiology at Harvard School of Public Health (HSPH), outlined the latest research and recommendations on PSA screening during a lecture at the School on July 30, 2013, part of the annual summer Hot Topics series.

Prostate cancer is the second leading cause of cancer deaths in US men, after lung cancer. Across the globe each year, 250,000 men die from the disease. Routine use of the PSA test has increased earlier diagnoses of the disease and has likely led to the observed decreases in prostate cancer mortality in many Western countries where PSA is widely used. However, it also has led to a spike in over-diagnosed tumors that would never cause harm for a man and would not have otherwise been identified. These patients then often undergo difficult treatments that they don’t need and which can have significant side effects such as erectile dysfunction and incontinence.

Recommendations from leading medical organizations regarding which men should be tested and when, and how to follow-up on an elevated result, are inconsistent, Mucci said.