PSA In The News

Prostate-specific antigen. To get screened for prostate cancer or not to get screened.


The results of two large studies, one in Europe (182,000 men) and one in the US (almost 77,000 men) made the front page of the New York Times today.  The studies seem to resolve what the New England Journal of Medicine calls “The Controversy That Refuses to Die.”


The prostate is a gland the produces much of the fluid that carries sperm. The prostate gland is located internally at the base of the penis. It surrounds the urethra, which is the small tube leading from the urinary bladder to outside the body. The urethra is also the tube through which the sperm carrying fluid exits the body. In young men the prostate is about the size of a walnut. It normally enlarges with age. It may become infected (prostatitis) or enlarge to such an extent that it interferes with urination. The prostate may also become cancerous.


Most prostate cancers are slow growing, some are not. However, in the presence of any prostate cancer the PSA test is positive. That is, the test will detect it. It then becomes a matter of deciding if the individual should proceed further in the testing and have a biopsy. If the biopsy detects cancer it means that the cancer has achieved a size that can be detected surgically. The next step is to decide what to do.


The options are:

  • Watch and wait.
  • Remove the cancer surgically.
  • Radiate the cancer.


Now, here is the problem that the studies looked at: what saves the most lives?


As it turned out, early detection of prostate cancer did not save lives to any significant degree. What it did is expose people to needless anxiety and surgery. Why? Because there is no way of telling which cancers are slow growing and which are not. Therefore, the researchers concluded that screening the general population for prostate cancer does no good and may do harm. All surgery carries some risk. Removal or radiation of the prostate carries the risk of incontinence and/or impotence.


Now the controversy – to screen or not to screen – can be put to rest.


Mary Lou Bernardo, PhD, MSN


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