Prostate Cancer Screening and the PSA test

What is “screening”

Population-based screening is where a test is offered to all individuals in a target group, often defined by age, as part of an organised program. (eg bowel, breast and cervical cancers)

Controversy regarding screening for prostate cancer

For screening

• Prostate cancer is a major health concern in Australia
  –second highest number of cancer deaths in men (after lung cancer). 3300 deaths per year
• Treatment for localised prostate cancer can potentially cure the disease. PSA testing reduces mortality BUT the question is whether the reduction is worth the individual and public health costs.

Against screening

• The PSA test may be abnormal when no cancer is present (“false positive”)
• PSA testing and subsequent biopsy can lead to the detection of cancers that are unlikely to progress and cause death (“overdetection”)
  The treatments for prostate cancer can have significant costs, side effects and impact on the quality of life of men
• Detection of slowly progressing cancers may result in treatment and potential side effects without health benefit.(“overtreatment”)
• At the present time, no test available that adequately differentiates between the aggressive cancers and those that are unlikely to impact a man in his lifetime.

Men have the option of discussing PSA testing with their GPs and specialists

• Issues to consider: Family history. the man’s health and life expectancy given other health issues, personal values, wishes, option of risk stratification with one off PSA testing in younger men