Another study shows PSA testing doesn’t save lives

Marc B. Garnick, M.D.

Editor in Chief,

By Marc B. Garnick, M.D., Editor in Chief, Annual Report on Prostate Diseases

For decades, men have been encouraged to undergo routine prostate cancer screening with a prostate-specific antigen (PSA) blood test. The thinking was that early detection of a prostate tumor would save lives. But two large studies released in 2009 did not definitively support that theory. (These findings—and the issue of PSA screening in general—are discussed in detail in the 2011 Annual Report on Prostate Diseases.) Now another trial, the longest-running one to date, offers more evidence that PSA screening does little to cut a man’s chances of dying of the disease.

The latest study, launched in 1987, followed 9,026 Swedish men for 20 years. From that population, 1,494 men were randomly chosen to be screened with digital rectal exams and, beginning in 1993, PSA testing; the rest of the men made up the control group.

Not surprisingly, more men were diagnosed with prostate cancer in the group that was screened for the disease than in the control group—5.7% vs. 3.9%. However, the researchers found no statistically significant difference between the two groups in terms of survival, even though the tumors found as a result of screening were generally smaller and had not spread. The results of the study were published online in the journal BMJ on March 31.

Such findings are undoubtedly confusing to men, who have been told for years that cancer screening is a “good thing.” While it’s true that PSA testing can help detect hidden prostate tumors, many such tumors are unlikely to cause problems during a man’s lifetime. Once diagnosed, however, many men feel compelled to treat the disease, risking erectile dysfunction, urinary incontinence, and bowel symptoms.

I don’t think this study, or the ones that preceded it, tell men to rule out PSA testing. Rather, as this new study reminds us, men should talk with their doctor to assess their personal risk of prostate cancer as well as the hazards and potential benefits of screening before having a PSA test.

Posted April 7, 2011


  1. Albert Peckham

    I was one of the fortunate males to have had a prostate biopsy and found (2012 at 72 y/o) that I had cancer of the prostate. I lived one year with “watch and wait”; the next year another biopsy found that the cancer had attached itself to one of the nerve bundles and I felt it required immediate attention. I found through a lot of research that MDAnderson, out of Texas, has an IMRT program that fitted my needs. After the IMRT program of 42 sessions, my PSA went from 9.5 to 1.4 in one year. Without the PSA tests, I could have been overcome with prostate cancer in less that 5 years.
    This doesn’t mean that I’m home w/o prostate cancer, it just means that I’m still here and viable albeit not in the same way I was before the treatments.

  2. Bill Sardi

    This is the problem with American medicine. In Britain, the PSA test is disregarded. There is considerable criticism now in treating diseases based upon markers. The result is needless treatment. Testing for PSA at all ages would just increase the rate of overtreatment, not prolong survival. Too many men, out of fear, demand treatment that will not save their lives. Patients and their loved ones are deceived by the calendar effect, that earlier detection equates with longer survival. Yes, true, from the date of detection, but the patients are dying on the same calendar day. Any prolongation in survival is imagined. The treatments are largely ineffective and alternatives need to be sought immediately upon confirmed diagnosis rather than after treatments have failed. Some of the most promising are molecular medicine approaches to prostate cancer, which includes natural molecules such as lycopene (tomatoes), resveratrol and quercetin(grapes, red wine), vitamin D (sunlight), vitamin E (tocopherols and tocotrienols), and the trace mineral selenium. There is growing evidence that these molecular approaches also enhance existing treatment, helping overcome treatment resistance and reducing treatment side effects. The prevailing problem is that patients and their loved ones demand something be done and will protest loudly if nothing is done. They will demand insurance pay for treatment regardless of efficacy. The same occurred for bone marrow transplants for breast cancer. Family members would run to the local newspaper to protest that insurance companies were rationing care and not living up to their agreement to pay for treatment. It was all for naught. Doctors share some blame for giving in to patient demands. I know some men who for years have lived with chronic prostatitis and elevated PSA. To biopsy, surgically excise and toxicate is to only provoke localized precancerous tissue into a spreading form of cancer. Hippocrates noted that it was better to leave tumors alone rather than treat. The first goal should be to keep tumors from spreading (metastasizing). Surgical invasion triggers the growth of new blood vessels (angiogenesis) in the wound healing process that can grow tumors. These new blood vessels then create a pathway for tumor cells to travel elsewhere. Surgical removal will still leave a few million tumor cells. Efforts to elevate activity of white blood cells to mop up roaming cancer cells and to inhibit adhesion of tumor cells to the walls of blood vessels would be strategies to prevent metastasis, which is the mortal form of the disease.

  3. Anette

    I think both doctors and men find PSA generally confusing.
    My neighbour who is 65 and has a PSA level of 7has been told he needs to have a biopsy by one doctor but another doctor is telling him level is normal for his age. Both doctors work in the same hospital. Who is right???

    • Suzanne Rose

      PSA levels appear to depend partly on age. A PSA of 5 ng/ml might be considered normal for a 73-year-old man, whereas a PSA of 3.9 ng/ml in a 50-year-old man might be a red flag. For that reason, some doctors and researchers advocate adjusting “normal” levels for different age groups. On the other hand, some doctors recommend that the threshold to biopsy be lowered to 2.5 ng/ml for men of any age. (Tradiationally, a biopsy has been recommended for men with PSA levels of 4 ng/ml and higher, though can can change if a man has a family history of prostate cancer.)

      One strategy pursued by some men in this situation who are reluctant to have an immediate biopsy is to wait several weeks and then have their PSA checked again. PSA levels can be elevated for reasons that have nothing to do with cancer. The results of the second test may help in making a decision about whether to have a biopsy.

  4. Natalie Amateur

    To care passionately for another human creature brings always more sorrow than joy.

  5. Kyanna

    Good point. I hadn’t touhhgt about it quite that way. 🙂

  6. prostate health

    I have read many negative reviews about PSA testing however I am always wondering why still it is the most common method the health providers are using today. Though I agree with you about its unreliability however I don’t think it doesn’t mean that it doesn’t save lives. I think it had also lives but not everytime it is used. Without PSA test, what could be the other way in diagnosing prostate problem that is most reliable then?

  7. Jesus navarrete

    PSA is always confusing for patients and even more for doctors, specially the last years.

  8. Tamara Wyman

    I believe a doctor has a responsibility to avoid making blanket statements that could cost lives. By advocating that PSA testing doesn’t save lives, he is generating a false sense of security for thousands of men who may never know enough to ask for a PSA test after experiencing erectile and urinary symptoms – especially at a young age. If people in responsible positions tell you “you don’t need it” and “that doesn’t happen to men under 50” – you just might believe it…

  9. Jen

    I am disgusted with this article! I just lost my husband at age 40 to prostate cancer. Yes, that is correct, age 40. He was diagnosed at age 35. After he was diagnosed we later came to find out that he did have a PSA test at age 33 . It was a 2.5 . Yes I understand that it is within “normal” range for a 50 year old but Not a 33 year old!!!! The doctor failed to do a follow up test. 2 years later he was diagnosed with stage 4 prostate cancer. I don’t understand what the big deal is to do a simple blood test!! If he had a follow up PSA maybe he would still be here today and they would have caught it sooner. This disease is attacking men younger and younger everyday. This is not an “old mans disease” anymore!! If a man complains of any symptom related to a prostate issue they should have a PSA done!!!! Oh, and by the way, we sued the doctor who failed to follow up and we WON!!!!!!

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