To PSA or not to PSA

By John Pickering 23/05/2012 5






GP: Yes, but we can monitor for changes.












For every 1,000 men who are screened with the PSA test:


For every 3,000 men who are screened with the PSA test:

  • 1 man will die due to complications from surgical treatment




Man:  Yes, in 3 months time.

Woman: Great.  Shall we go out for dinner?



  4. GPs should explain that:
  •            there are risks with biopsies, and


I wonder, would you have a PSA test?

Tagged: medical tests, prostate cancer, PSA, Risk

5 Responses to “To PSA or not to PSA”

  • Thanks for this really good summary.

    FWIW, the teaching and reading I have had on the role of PSA is that its role is to monitor the tumour load of someone who already has the diagnosis of prostate cancer, i.e. it tells us how effective treatment is.

    It’s not appropriate to use PSA as a screening tool; the morbidity and mortality that arises with investigation of false positives has huge costs to the patient, their family, and to the country as a whole.

    I would like to know why health insurance companies still use it as part of their screening despite its lack of efficacy. None I have approached have given me an answer.

    Anecdotally, my fathers’ GP used it as a screening test on him, recording 4.2. A repeat at 12 months was 9.6. Further investigation showed a high grade carcinoma that was successfully treated without any morbidity. It’s the one case I am aware of where it was useful as a “screen” and probably prevented a death.

    Despite this, would I have a PSA done on myself for screening purposes? The answer is a definite NO.

  • I went to a talk by a clinical colleague of mine today and they were talking about the risk of getting a really nasty infection through having the biopsy. Its pretty high. And all that because of a test with a really high rate of false positives? Doesn’t sound worth it.

  • Good points Stuart and Siouxsie. I’ve been thinking about why the Urologists may have come out so strongly against the report. A cynical view would be that without the test they would get fewer referrals. To be fair, though, they seem to be saying that it is “the best they’ve got.” My own research is about tests in nephrology that are also poor. The difference is that the treatment options are not (yet) doing more harm than good. It’ll be interesting to see if Medsafe make any moves to “review” the test.

  • Excellent review and sound conclusion.

    As far as I’m aware Medsafe has no control over the use of PSA tests in medical laboratories.

    The MOH essentially agreed with the Health Select Committee’s inquiry into prostate screening of otherwise healthy people which concluded; “There is no currently no evidence that shows a population based screening programme for men with no symptoms of prostate cancer would improve outcomes for men, however men who are concerned can be tested if they choose to…. Prostate cancer is an important menâ€™s health issue and preventing deaths from prostate cancer is a high priority. However, there is no conclusive international evidence that screening for prostate cancer saves lives, nor whether the potential benefits of this testing outweighs the associated risks.

    Current international best practice is not to have a screening programme for prostate cancer. The British Association of Urological Surgeons states â€œProstate cancer screening cannot be justified on current evidence. PSA testing should only be performed after full counselling. There is no evidence to support opportunistic screeningâ€.

    There are different views even among urologists, and most urology professional bodies are clear that the evidence is still insufficient to actively encourage men to be tested…”

    Urologists clearly have a vested interest in maintaining routine testing.

  • By the way, the graphic should be rotated and raised… there are far more false positives than true positives…