PSA test leading to 'overtreatment' of prostate disease

Ahead of a review by the NHS, the PSA test for prostate probelms took another blow today with the publication of US research suggesting that many men with low-risk prostate cancer are getting aggressive treatment, increasing the risk of dangerous side effects.

Earlier this year, the man who invented the PSA - or prostate screening antigen – test, Dr Richard Ablin said that the test’s use in the USA had become a ‘hugely expensive public health disaster’.

In the Archives of Internal Medicine, Yu-Hsuan Shao of the Cancer Institute of New Jersey in New Brunswick writes: ‘The tremendous improvement in (prostate cancer) survival has been attributed to early detection and treatment. However, there have been concerns about the potential overdiagnosis and overtreatment of localized prostate cancer.’

The problem is that although the test can indicate a problem with the prostate, it cannot distinguish between the aggressive and slow growing forms of the disease.

John Neate, Chief Executive at The Prostate Cancer Charity, explains: ‘Prostate cancer is a complicated disease and, unlike other common cancers, does not always require treatment. Whilst being the best test currently available, the PSA blood test is not able to detect cancer specifically, only that there may be a problem with the prostate.

‘Research suggests that screening may be beneficial for some men as it may detect their cancer at an early stage, when treatment can be most effective. However, we would need more evidence to show that the benefits of screening outweigh the harms before screening could be introduced in the UK.’

UK consultation on PSA screening

The UK National Screening Committee's current view is that PSA-based screening should not be introduced in this country. But interest in the usefulness of the PSA test as a screening tool has grown in recent years and the Committee has been assessing all of the available evidence into prostate cancer screening and is currently consulting on the expert review which it has commissioned. The consultation runs until 21 September.

Writing in the New York Times, Dr Richard Albin pointed out that infections, over-the-counter drugs like ibuprofen, and benign swelling of the prostate can all elevate PSA levels.

PSA testing does have a role, he said. One example is the use of the test to follow patients who have had treatment for prostate cancer, where a rapidly rising score indicates a return of the disease.

However, Dr. Ablin stated categorically that PSA testing ‘should absolutely not be deployed to screen the entire population of men over the age of 50, the outcome pushed by those who stand to profit.’

Despite the drawbacks, the Prostate Cancer Charity believe the PSA test does have its uses. John Neate said: ‘it is critical that we move swiftly to ensure that all men aged over 50, and younger men at higher risk of prostate cancer, are made aware of the PSA test, their right to request one and have the opportunity to make an informed decision about whether to have it. We encourage every man with concerns about prostate cancer to visit their GP and ask for balanced information about the pros and cons of the PSA test to help them decide whether having it is right for them.’