Originally published 8/15/2016
My, how times have changed! Since we posted the original blog nearly 8 years ago, the 2012 recommendation against PSA screening by the U.S. Preventive Services Task Force (USPSTF) has taken a toll on men.
According to a 2022 study based on national survey data, the average number of PSA tests during the previous five years dropped from 2010 to 2018:
- In 2010, men age 40 and above reported 4-5 PSA tests
- In 2015, men age 40 and above reported 1-3 PSA tests
- In 2018, men age 40 and above reported no PSA tests.[i]
However, these general numbers don’t reflect specific age-related trends during the same period. By 2018, men ages 70-79 reported a greater tendency to have had 4-5 PSA tests during the last five years than men ages 55-69. Thus, PSA intensity remained greater in older men in spite of USPSTF’s discouraging screening among older men. The data also doesn’t reflect an alarming trend: more men are now being diagnosed with later stage PCa because they didn’t have annual PSA tests!
While the task force strongly urges doctors to discuss with each patient the benefits and risks of a PSA test for his unique PCa risk profile, in fact the above patterns may reflect common physician practices that are not necessarily in patients’ best interests: “… physicians were aware and knowledgeable of guidelines; they overestimated the benefits and underestimated the harms of PSA screening; they deferred to patient preference when deciding whether to order a PSA test; and they were reluctant to change management for patients doing well.”[ii] The original blog below outlines our own suggestions to improve the situation.
The debate over the merits of prostate cancer screening by using the prostate specific antigen (PSA) blood test is not likely to go away any time soon. However, the majority of men between ages 50-70 will continue to have blood tests to screen for prostate cancer (PCa). According to experts, more than two-thirds of men with an elevated PSA will not be diagnosed with PCa.[iii] For many of them, confusion and uncertainty will linger for several reasons:
- They don’t understand what an elevated PSA means, especially because it might be an indicator of normal prostate enlargement, an inflammation or infection, or simply an artifact of certain activities within 24 hours of the blood draw
- They aren’t aware of the connection between PSA and other risk factors for PCa such as family history or exposure to toxins
- They don’t know how their individual test results are related to any other management plan for their health.
Some portion of these patients will be proactive and seek out information on the internet, in books, or from talking to or blogging with others. Although none of this can replace medical advice from their own doctors, they may find reassuring answers and fact-based education. The risk, of course, especially when talking or blogging with others, is that it’s like the blind leading the blind. A man who shares his own experience with another may be inadvertently contributing false confidence or needless worry.
The person most able to remove doubts, confusion and uncertainty is the patient’s own doctor. It is important that doctors who receive lab results take time to go over them with the patient and explain what the PSA value does and does not mean for each individual. Whether the physician is a family doctor, internist, urologist, whatever—it’s important for doctors to remember that in general patients are rather mystified by numerical values and technical terms. Spending a few extra minutes and using everyday words can make the difference between a lingering mental muddle vs. “Oh, now I get it!”
We owe patients peace of mind and clear understanding. We have better tools and knowledge than ever to explain to men whose PSA is elevated and/or risking what it might indicate and what options they have. We also have less fearsome alternatives than sending patients for an immediate random TRUS biopsy. These include getting a more well-rounded analysis of the PSA blood draw to being with, including PSA, free PSA, and total PSA; putting these values side by side gives better information than a single PSA number.
We do men a favor when we don’t assume they automatically grasp the implications of PSA. We help men best when we offer an explanation, then ask if THEY have any questions—and give them a minute to think about it. In this way, we spare them any uncertainty and deepen their trust in us as professionals.
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.
References
[i] Richards TB, Dai S, Gray SC, Hall IJ, Siegel DA. Number of prostate-specific antigen (PSA) screening tests in the last five years reported by men in the United States in 2010, 2015, and 2018. Urol Oncol. 2022 May;40(5):192.e19- 192.e25. doi: 10.1016/j.urolonc.2022.01.016.
[ii] Ibid.
[iii] Biddle C, Brasel A, Underwood W 3rd, Orom H. Experiences of Uncertainty in Men With an Elevated PSA. Am J Mens Health. 2015 May 15. pii: 1557988315584376. [Epub ahead of print]
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.
