PSA: Screening versus Testing
Urologists have cajones. Who else would issue new guidelines on use of the PSA test in the face of a huge failed Phase III trial of PSA screening? For nearly 20 years we asked, “Does PSA screening save lives?”. The USA answer, NO. The European answer, YES but the benefits are exceedingly small (1500 screened to 50 radical surgeries to save 1 life). The number needed to treat makes the test diffcult to accept as a screening tool.
But the AUA is not afraid to suddenly say that PSA testing (not screening) at age 40 can help doctors diagnose, assess risk, and stage prostate cancer. All without any Level 1 evidence. What is this “Groundhog Day”?
Now truth be told, I like this idea, I like this use of the test. I think it makes intuitive sense. But so did PSA screening. I think we all need to do a much better job explaining this test and what we know and don’t know. And mostly we don’t know.
Download the guideline at the AUA website
