Prostate Cancer Screening: Pros & Cons of PSA Screening Test

By Dr. Tushar Aditya Narain in Uro-Oncology

Nov 30 , 2023 | 2 min read

Prostate cancer is one of the most common cancers among men, with millions of new cases diagnosed worldwide each year. In this blog, we'll delve into the world of prostate cancer screening, focusing on the PSA test and exploring its advantages and disadvantages.

What is the PSA Test?

PSA stands for Prostate-Specific Antigen, a protein produced by the prostate gland. It measures the level of this protein in a man's blood. Elevated PSA levels can indicate various prostate issues, including prostate cancer.

However, it's important to note that a high PSA level doesn't definitively diagnose cancer; it simply prompts further investigation.

The Pros of PSA Screening

Early Detection:Perhaps the most significant advantage of PSA screening is its potential to detect prostate cancer in its early stages. Identifying cancer before it spreads beyond the prostate gland significantly improves treatment outcomes
Monitoring: PSA testing can be beneficial for monitoring changes in PSA levels over time. A consistent rise in PSA levels might signal the need for further evaluation, including a prostate biopsy
Informed Decision-Making: PSA screening provides valuable information that allows individuals and their healthcare providers to make informed decisions about their prostate health. It helps identify those at higher risk who may need closer monitoring or intervention.
Risk Reduction: Detecting and treating prostate cancer early can reduce the risk of the disease progressing to an advanced stage, which can be more challenging to treat

The Cons of PSA Screening

False Positives: PSA levels can be elevated due to factors other than cancer, such as benign prostatic hyperplasia (BPH), inflammation, or infection. This can lead to false-positive results, causing unnecessary anxiety and invasive follow-up procedures like biopsies
False Negatives: Conversely, the PSA test may miss some cases of prostate cancer, resulting in false-negative results. This can provide a false sense of security, delaying necessary treatment
Overdiagnosis and Overtreatment: PSA screening can detect slow-growing, non-aggressive prostate cancers that may never cause symptoms or harm in a man's lifetime. This has led to concerns of overdiagnosis and overtreatment, as some individuals may undergo unnecessary treatments and experience potential side effects
Uncertain Impact on Mortality: While PSA screening has led to increased detection of prostate cancer, its impact on reducing prostate cancer-related mortality remains a subject of debate among experts
Costs and Resources: PSA screening, follow-up tests, and treatments can be costly, both financially and in terms of healthcare resources. There is ongoing discussion about whether the benefits justify these expenses
Making Informed Decisions: In light of the pros and cons of PSA screening, it's essential for individuals to have informed discussions with their healthcare providers about whether to undergo screening. Factors such as age, family history, and overall health should be considered when making this decision

Some organisations, like the American Cancer Society, recommend that individuals discuss PSA screening with their healthcare providers starting at age 50 (or earlier for those at higher risk). Others advocate for shared decision-making, allowing individuals to weigh the pros and cons before choosing whether to undergo screening.

Ultimately, the decision to undergo PSA screening should be individualised and based on a thorough understanding of the potential benefits and drawbacks. It's a step towards taking control of one's prostate health and making choices aligned with personal values and priorities. Regular communication with a healthcare provider is key to navigating this complex decision-making process and ensuring the best possible outcomes for prostate health.