PSA Testing
Our Position
The Urology Foundation does not support the introduction of a national screening programme for prostate cancer which uses the Prostate Specific Antigen (PSA) test.
Although research has been conducted which shows that using the PSA test could possibly save the lives of a significant number of men, the same research shows that it can lead to many more men being unnecessarily, and potentially harmfully, treated for non-aggressive forms of the disease.
We do, however, support men’s right (including asymptomatic men) to a PSA test from the age of fifty, in conjunction with informed consent and counselling. We also believe that men in ‘at risk’ categories, such as black men and men with a family history of prostate or breast cancer should have access to a PSA test from the age of 45.
What is a PSA test?
A Prostate Specific Antigen (PSA) test is used to detect prostate cancer. PSA is a protein made only by the prostate gland. The amount of it that you have in your blood is often an indicator of prostate disease of some kind. A raised level of PSA may indicate prostate cancer, but it could also indicate an enlarged prostate, prostatitis or a urinary infection.
Background
Given the commonality of prostate cancer among males over fifty, there has been pressure placed upon the government to establish a nationwide screening programme for the disease, much like with cervical and breast cancer with women.
PSA testing, often combined with a digital rectal examination, is currently the most widely used test to check for prostate cancer. Many men have expressed that it was a PSA screening that alerted them to their cancer, and subsequently saved their life. The research backs this up to some extent, demonstrating that PSA testing can reduce deaths from the disease by as much as 27%.
Despite this undoubtedly positive effect, the evidence displays a number of drawbacks which inform The Urology Foundation’s stance on a nationwide screening programme.
Put simply, the PSA test is not reliable.
Two in three men with a raised PSA level do not have prostate cancer, while one in six with a normal PSA level do have the disease.
The effect of such unreliability is the creation of misplaced reassurance or unnecessary anxiety. A PSA test is also unable to establish between slow-growing and fast-growing cancer, which further compounds its limitations.
Some prostate tumours are non-aggressive and some move slowly enough that in older men, undergoing treatment is not necessary. PSA testing on a grand scale could potentially lead to over-intervention; aggressively, and potentially harmfully, treating non-aggressive conditions. Biopsies, to check whether cancer is present, can also prove harmful and some patients may contract septicaemia and, in rare cases, even death.
The treatment of prostate cancer can also have serious side-effects.
It is for these reasons that instead of a nationwide screening programme, The Urology Foundation believes that men should be assessed on an individual basis, which may involve PSA testing if desired on an informed consent basis.
The Urology Foundation is currently supporting a number of research studies looking into the presence of proteins of biomarkers in the blood or urine that can indicate not only whether prostate cancer is present, but also whether the cancer is likely to be slow growing or aggressive. Should this research prove successful, we would hope for the introduction of a blood or urine test that can accurately detect the presence of cancer and its potential harm, which may in turn lead to a more reliable test for screening.
