Originally published 12/27/2015
There are not a lot of studies that probe men’s feelings toward the PSA blood test as a screening tool for prostate cancer (PCa). To update the blog below, here are some additional survey results:
- A 2012 Canadian survey at 2 clinics reported, “Despite a limited body of evidence showing its effectiveness, Canadian men continue to have a favourable impression of PSA screening…”[i]
- A 2019 Australian study found that saw participation in screening as a way “…to prevent cancer and gain reassurance about their health, particularly when supported or prompted by their social networks or healthcare providers.”[ii] However, there was also some reticence due to a lack of clarity regarding its necessity, and the potential for higher costs (additional testing/treatment).
- A 2019 Swedish survey demonstrated that men’s feelings toward PSA screening depended on their situation. If they were healthy and not already diagnosed with PCa, they saw screening as a “lifeline” when their PSA was repeatedly low and stable. However, once diagnosed and treated, the PSA test as a monitoring tool tended to provoke anxiety; and, if a blood test revealed a rise in PSA, “Most men experienced more worry and fear of death … than they did when their cancer was initially diagnosed.”[iii]
Other studies on men’s perceptions and attitudes toward PSA testing found that willingness to participate in screening varied with patient age, education level, knowledge about PCa and its risks, and the belief that the PSA test is useful. What’s your personal opinion?
It’s hard to believe it’s been two years since the U.S. Preventive Services Task Force stirred up controversy by recommending against routine PSA screening. They were concerned about overdiagnosis and overtreatment due to the nonspecific nature of an elevated PSA. Overreacting (if it can be called that) is potentially costly: patients pay a lifestyle price, and healthcare spending is stretched thin. The panel examined research done in Scandinavia and the U.S. suggesting that prostate cancer screening did not confer a longevity or survival advantage. Therefore, they concluded that unless known risk factors existed (heredity or exposure to known carcinogens) doctors should discuss with individual patients the merits of PSA testing.
A survey was conducted of over 1,000 men with no previous history of prostate cancer, asking their feelings about prostate cancer screening. Just over half (54%) of men ages 40-74 said they still want PSA testing despite the Task Force’s advice.
Over 75% of the men surveyed said they were not aware of the Task Force’s conclusions, but they understood the reasoning once it was explained to them. Even then, only 13% said they would not choose testing. Men most likely to opt for screening included black men, men with higher incomes, and those who had had a PSA test within the previous two years. Dr. David F. Penson, health policy chair for the American Urological Association (AUA), commented, “The men in the study may be saying that while, in general, they may agree with the USPSTF recommendation for large populations, when they consider their individual situation and their personal preferences, they would rather be tested and know their status.”[iv]
Personally, I think we’ve made huge strides since the Task Force recommendations. PSA as a biomarker for prostate cancer is extremely problematic, but more recent developments such as the PHI (Prostate Health Index) blood test or genetic tests are more accurate pointers toward the need for a biopsy. Even better, if test results come back suspicious for prostate cancer, 3T multiparametric MRI is a noninvasive and virtually definitive way to rule the need for a biopsy in or out.
Men want to know what’s going on in their bodies, and they want sufficient notice (early detection) to give them the greatest freedom of informed choice in making a plan if something is wrong. What better way than a “snapshot” of the state of your prostate health? A blood test is a step in the right direction; 3T mpMRI offers visual evidence that takes you the rest of the way.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
[i] Smith SD, Birtwhistle R. Exploring patient perceptions of PSA screening for prostate cancer: risks, effectiveness, and importance. Can Fam Physician. 2012 Sep;58(9):e502-7
[ii] James LJ, Wong G, Craig JC, Hanson CS et al. perspectives of prostate cancer screening: A systematic review of qualitative studies. PLoS One. 2017 Nov 28;12(11):e0188258.
[iii] Rönningås U, Fransson P, Holm M, Wennman-Larsen A. Prostate-specific antigen (PSA) and distress: – a cross sectional nationwide survey in men with prostate cancer in Sweden. BMC Urol. 2019 Jul 12;19(1):66.
[iv] https://www.sciencedaily.com/releases/2013/07/130709091415.htm
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
