The US Preventive Services Task Force recommend against routine prostate-specific antigen (PSA) testing.
The PSA test was introduced in the late 1980s. This lab test showed us that the incidence of prostate cancer increased dramatically compared to when we could not easily diagnose it. Even though we were able to diagnose men with prostate cancer, the death from prostate cancer decreased only a little bit. A European randomized controlled trial shows that 1,055 men would have to be screened for nine years to prevent one death from prostate cancer. The PSA blood test has started a “conundrum of overdiagnosis” which is a difficult situation. We cannot tell at the time of diagnosis who is overdiagnosed (and will live with prostate cancer uneventfully) and who has clinically significant disease (and may die from prostate cancer).
25 years after the introduction of PSA testing, two lessons have been revealed. A screening test for cancer should not be introduced until trials have shown that the test leads to significantly reduced mortality. Secondly, (without evidence showing net benefit or harm) PSA testing is likely to remain controversial until it is replaced by a better test. We do not have a significantly better screening test for prostate cancer at this time.
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