Cancer is often treated as a condition that absolutely must receive treatment, yet prostate cancer does not always need to be treated, and there are some pros to not treating it. Screening for cancer through a prostate-specific antigen (PSA) has also faced some scrutiny. Fewer than one in three men who screen for the antigen talk about the risks and benefits with their doctor beforehand.
Prostate specific antigen is a naturally occurring protein secreted by the prostate that can be elevated for a number of reasons unrelated to prostate cancer. It may be a sign of age-related enlargement of the prostate, but it also has the possibility of being cancer-related.
This is where many disagreements for PSA screening arise. Routine testing for PSA happens in otherwise healthy individuals. When a person tests has elevated PSA levels, the only way to confirm they do not have prostate cancer is to perform a biopsy—tissue removal for examination. This may lead to complications such as infection, bleeding, or pain. The fact of the matter is that even if prostate cancer is confirmed, treatment can be very challenging and sometimes unnecessary.
According to researchers at Brown University, this information needs to be shared with concerned patients, outlining the risks versus the benefits of getting screened for PSA. The United States Preventive Services Task Force (USPSTF) has previously recommended against routine screening of PSA, but have since now recommended that a discussion between a man and his doctor should guide whether they receive the test or not. This new recommendation may open the door for more unnecessary screening to occur, leading to more unnecessary treatment.
“That only about a third of patients [in the study] reported having a discussion of advantages and disadvantages is an alarming statistic,” study author Dr. George Turini III said in a news release from the Rhode Island university.
The researchers go on about how simply receiving the news about a potential cancer risk when elevated PSA levels are seen may cause undue emotional stress on patients. The study found that most of the men undergoing testing without being aware of all the risks and benefits typically included low income, lack of high school level education, uninsured, or Hispanic men.
Most health care professionals and researchers are unsure why the USPSTF has made this change in recommendation, with most saying that more study is needed to make sure men are getting the information they need to make an informed decision about PSA screen tests.
“We believe our findings may be indicative of a shift in practice patterns away from detailed prescreening discussions among health care providers who have implemented the 2012 (USPSTF) recommendation into their caregiving,” the study authors wrote.