Prostate cancer: A PSA researcher questions PSA tests
When news came Thursday evening that the U.S. Preventive Services Task Force would recommend that middle-age men forego routine PSA tests to screen for prostate cancer, at least one longtime researcher rejoiced.
“I couldn’t agree more with the decision,” said Richard J. Ablin, a research professor of immunobiology and pathology at the University of Arizona College of Medicine who worked on the discovery of PSA, a protein made by the prostate. “It’s a test that really can’t do what it’s purported to do.”
For around 40 years, Ablin has argued that most men shouldn’t go through with PSA screening because it doesn’t actually detect prostate cancer -- rather, it measures levels of PSA in the blood that may or may not indicate the presence of cancer (which must be confirmed through further tests.) Men with high PSA levels can be cancer-free; men with low PSA levels can have aggressive cases of the disease.
Looking at more men’s PSA levels can lead to more biopsies and more detected cancers. But, Ablin said, even if prostate cancer is ultimately found -- and it often will be -- that doesn’t mean treatment, which can lead to impotence and incontinence, makes sense. Most cases of prostate cancer are not aggressive, he said. “The majority of men die with it, and from something else,” he said.
“We’ve overdiagnosed and overtreated over a million men,” he added.
Ablin doesn’t think PSA tests are completely useless. For men who have had the disease and had their prostate removed, it can detect a recurrence, he said. And high-risk patients who find they have slightly elevated levels can benefit from stepping up their vigilance.
“What I’m telling people to do, if someone in your family had it, get a PSA test and write the number down,” Ablin said. “Six months or a year later, get another test. If it goes up gradually, take another look...it’s not necessarily cancer. Look at it as a smoke alarm.”
“I’m happy,” he said of the new recommendations. “We’re brainwashed that doing more is doing better.”
