Excessive PSA or Excessive Biopsy?
The New York Times recently published an article by Shannon Brownlee and Jeanne Lenzer called “Can Cancer Ever Be Ignored?” This article brings needed attention to the rampant misuse of a powerful tool called the PSA (prostate-specific antigen) test. Unfortunately, the arguments mustered in the article, both pro and con, miss the crux of the issue.
No one disputes that PSA testing leads to earlier detection of prostate cancer. In fact, one could argue that the problem with PSA is that it works too well, diagnosing the disease years before we even need to know about it. Media attention, therefore, needs to be refocused on how doctors respond to an elevated PSA, rather than recommending the end of testing altogether.
Presently, doctors urge immediate prostate biopsy, taking a dozen needle samples of the gland through the rectum. More than one million men undergo this unpleasant procedure annually, risking serious infections, bleeding and temporary impotence.
The problem of over-diagnosis and over-treatment of prostate cancer is rooted in the performance of immediate biopsy at the first sign of even a slight increase in PSA. A better, more sensible medical response would be additional testing with urine tests and scans, along with thorough patient education about the risks of biopsy; including the risk of having to deal with a small, innocuous growth inappropriately diagnosed as cancer.
Rather than shooting the proverbial messenger, let’s educate the medical community about how to use the information PSA provides more judiciously. We can’t forget that 30,000 men die annually from advanced prostate cancer, and twice that many are living and suffering from the ravages of metastatic disease in their bones. Studies clearly indicate that early diagnosis leading to the selective use of appropriate treatment reduces mortality rates.
Mark Scholz, MD
Author, Invasion of the Prostate Snatchers
Medical Director, Prostate Oncology Specialists Inc
Executive Director, Prostate Cancer Research Institute