Prostate cancer survival for men with metastatic disease significantly improved with routine Prostate Specific Antigen (PSA) testing over the last 20 years, despite a current US Preventive Task Force’s (USPTA) recommendation against general screening. A study in the Journal of Urology showed a significant reduction in the stage severity of the cancer in men who followed with testing. Overall survivability increased for men with metastatic disease who underwent screening, especially black American men. The study leaves no doubt that PSA testing plays a role in extending lives for such patients. It also supports the use of PSA testing for general screening in asymptomatic patients.
There has been a lot of controversy about the USPTA’s recommendation against testing. The government claims that the benefits of testing are outweighed by the harm and cost of doing biopsies many of which are negative. Dr. Wilt who was one of the authors of the USPTA recommendation felt that the study was interesting but that increased survival could be due to many factors other than the PSA test. However physicians have used PSA testing for the last 20 years and many still consider it an important part of preventive care.
Early diagnosis cancer is the most important factor for better outcomes with often less invasive treatment and improved survivability. A delay or failure to diagnose cancer caused by failing to properly screen a patient for prostate cancer by way of history, examination and testing can cause irreparable harm with a poorer outcome. Rectal examination with careful prostate palpation by an experienced clinician is a proper part of prostate care. Monitoring for signs of urinary problems, such as obstruction of flow, and reporting changes to physicians are important. The specific medical facts of each case are important in determining if PSA testing should be done.