Why I Won’t Have a PSA Test When I Turn 50

Generations of patients and doctors have been steeped in the myth that any kind of cancer should be found as soon as possible and when found, removed. The image of a gray-haired doctor on television telling the frightened patient “if only we had caught it sooner…” has convinced us all that cancer must be diagnosed ASAP.

But it turns out that diagnosing prostate cancer sooner hurts more than it helps. For the last two decades many men over 50 have been regularly screened for prostate cancer with a blood test called PSA (prostate specific antigen) despite the fact that there was never any evidence that this test saves lives.

Last October the US Preventive Services Task Force (USPSTF) reviewed the available studies about screening for prostate cancer. Their preliminary recommendation was against routine screening of men at any age for prostate cancer. (” target=”_blank”>editorialist in the Annals of Internal Medicine who wrote in support of the USPSTF recommendations quoted Upton Sinclair who said “It is difficult to get a man to understand something, when his salary depends on his not understanding it.”

So I will start explaining to my male patients the known harms and the unproven benefits of PSA screening. For many patients this will be a slow and difficult psychological shift. Many patients will still request the test out of habit or simply because they don’t yet believe the new recommendations. That’s fine. They’re the boss. I only give advice.

In six years I will turn 50. I tell all my patients that I’ll celebrate by undergoing a colonoscopy for colon cancer screening. I will certainly not have a PSA checked.

What we urgently need is a new test that discriminates aggressive prostate cancer from the more common harmless prostate cancer, and we need less harmful treatment options. I have six years to wait for such advances. Meanwhile, a very nice man who has been my patient for over a decade is scheduling his prostatectomy in the next few weeks. I hope he does well.

Learn more:

” target=”_blank”>Government task force discourages routine testing for prostate cancer (Washington Post)
” target=”_blank”>Screening for Prostate Cancer: U.S. Preventive Services Task Force Recommendation Statement
” target=”_blank”>Prostate Cancer Screening: What We Know, Don’t Know, and Believe (Annals of Internal Medicine editorial)
” target=”_blank”>National Panel Advises Against Prostate Cancer Screening (my post last year about the USPSTF PSA recommendations)

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor.