As PSA Tests Drop, Adv. Prostate Cancer Cases Rise

By Serena Gordon

HealthDay Reporter

WEDNESDAY, May 20, 2020 (HealthDay News) — Prostate cancer screening guidelines have been evolving for more than a decade, but new research suggests that recommendations against routine prostate cancer testing may have come at a steep price — more men getting diagnosed with advanced prostate cancers.

The study found that rates of advanced prostate cancers rose by about 5% per year through 2016.

There was some good news, though. After routine use of the prostate specific antigen (PSA) test was no longer recommended for the majority of men, rates of early prostate cancer went down by 6.9% per year in men between 50 and 74 years old. (Early prostate cancers may be very slow-growing and may not need treatment.)

“Men have to talk with their providers. They have to make sure they understand all of the benefits and harms of PSA testing. The benefits are that they may avoid advanced disease and may extend their life expectancy,” said senior study author Dr. Ahmedin Jemal, scientific vice president of surveillance and health services research for the American Cancer Society.

But there are also potential harms from getting a PSA screening. Some are from treatment, but there are also harms from the need for further testing after a PSA test shows possible cancer. After a suspicious test result, a doctor may suggest a biopsy. That’s a procedure to remove a small sample of tissue from the prostate.

“Biopsies can lead to bleeding or infection. And, 1 in 100 biopsies lead to hospitalizations,” Jemal said.

The problem is that prostate cancer screening isn’t clear-cut. The PSA test can be helpful, but not always. The PSA measures prostate-specific antigen — that’s a substance made by cells in the prostate gland. It can be made in normal and cancer cells, according to the American Cancer Society.

The higher the PSA level, the more likely it is that a man has prostate cancer. But there’s no set point where a man can be sure he has cancer (or doesn’t). So an unusual PSA finding may lead to additional testing.


Because of these uncertainties, the U.S. Preventive Services Task Force recommended against PSA screening for men 75 and older in 2008. In 2012, the USPSTF expanded that recommendation to include men of all ages. At the time, the task force concluded that any potential benefits from screening wouldn’t be greater than possible harms from tests like the PSA.

In 2018, however, the task force reviewed newer research and revised its recommendations. It still recommends that men aged 70 and older forgo PSA screening. For men 55 to 69 years old, the task force says the decision to scree

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