PSA Screening–Yes or No?

This week the United States Preventive Services Task Force recommended against the PSA prostate cancer screening test for men. Many people are confused because, of course, urologists (the doctors who end up doing all the procedures that result from the PSA test) as a group tend to disagree with the new recommendations.

The same group has recommended against routine mammography for women in their forties which generated heated disagreement from the radiologists (who do the test and resulting procedures).

But many physicians and others with no professional or financial interest in either of the two tests continue to recommend them. That means that you, the patient, have to make a decision on whether to get screened in the face of disagreement between experts.

So, how do you decide?

You have to decide if the benefits of the screening test (lives saved) outweigh the costs (lives lost or complications caused by treating disease that would never have hurt the patient). Unfortunately, it is not black and white.

A great place to start is with the article by H. Gilbert Welch, MD in the October 10, 2011  New York Times  op ed article “You Have to Gamble On Your Health” at

Dr. Welch states that one death from breast cancer  is prevented for every 1000 people screened over ten years but at a cost of 5 to 15 persons who are over-diagnosed, meaning they receive treatment that has side effects (including death) for disease that would not have killed them.

For prostate cancer screening the number is 30 to 100 persons over-diagnosed for every 1000 persons  screened. The side effects for overdiagnosis of prostate cancer include death, incontinence, and impotence.

In the case of mammography and PSA testing, the question you have to decide is—is the benefit of the screening worth the cost to you in possibly unnecessary treatment. You have to study the numbers and you have to decide.

Dr. Welch states in the article that he, a 56 year old man, has decided not to get screened for prostate cancer. He also says that he believes, if he were a woman, that he would not get screened for breast cancer.

There are other rational people including doctors who have studied the numbers and who understand them and some decide to get screened and some decide not to.

Dr. Welch is co-author of a new book called Overdiagnosed: Making People Sick in the Pursuit of Health. The book will give you more information to help you decide what’s right for you.

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