To Screen or Not to Screen… A Urologist’s POV on PSA Screening

To Screen or Not to Screen… A Urologist’s POV on PSA Screening


Editor’s Note: Since women make the majority of healthcare decisions for their families, we thought our GLOW members and blog readers might be interested in this article on Prostrate-Specific Antigen (PSA) screening. Should the man in your life be screened for PSA? Read on to hear the opinion of our urologist, Dr. Daniel Simon.

By now, most people have heard about the recommendations made last year by the U.S. Preventative Services Task Force (USPSTF) advising healthy men to forgo the PSA test for prostate cancer screening. As a new Urologist on staff at Valley Medical Center, I thought I would take this opportunity to introduce myself and share my opinion on PSA screening.

While I agree that reform in the screening and treatment of prostate cancer was needed, I believe the USPSTF issuing a blanket statement against PSA testing did a disservice to American men, particularly those at higher risk for prostate cancer (such as African-Americans and men with a first-degree relative with prostate cancer).

It is true that the PSA test is not a perfect test–there is no PSA level that guarantees the absence of cancer, and most men with an elevated PSA do not have cancer. Accordingly, PSA screening has led to unnecessary biopsies, and has exposed men to the side effects of radical treatment for low risk cancers that may have posed little danger to life or health.

However, PSA remains the only widely available test to help identify asymptomatic men with prostate cancer, and continues to be a valuable tool when interpreted in the context of family and medical history, physical examination, and prostate size. In fact, PSA screening does reduce mortality from prostate cancer in men who would not otherwise have been screened.

Thus, rather than abandoning a valuable test because of its flaws, we can make better use of PSA than we have historically. First, it is important to know when not to screen. Men who are 70 years and older, have a life expectancy of less than 10 to 15 years, or are younger than 55 without risk factors for prostate cancer may not benefit from screening. Second, abnormal PSAs do not always require an immediate biopsy. Instead, repeating the PSA test in several weeks, ordering a free-to-total PSA, and new tests like the PCA3 test can help to accurately assess the risk of an elevated PSA.

Lastly, many detected cancers are low risk and do not need immediate treatment. Active surveillance should be considered in anyone with a low risk cancer, and even for intermediate risk cancers in elderly men. With a regimented program of repeat PSAs and follow-up biopsies, we can separate patients with non-aggressive cancers from patients with more dangerous cancers that need definitive treatment, and thereby reduce treatment-related morbidity. It is only through listening to both sides of the PSA screening argument that we can give patients the benefit of early detection and effective treatment for prostate cancer, while reducing the risk of harm associated with over-diagnosis and over-treatment.

Dr. Simon can be contacted at the Urology Clinic at Valley Medical Center: 425.656.5365. 

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