Another Study Demonstrates That Prostate Cancer Screening Does More Harm Than Good

by Heidi Stevenson

25 September 2009

Another new study, reported in the British Medical Journal, documents that routine prostate screening tests probably do more harm than good, as I have previously reported here, along with an explanation of why the PSA test is inadequate.

In this study, Prostate specific antigen for early detection of prostate cancer: longitudinal study, lead researcher Benny Holström found that "No single cut-off value for prostate specific antigen [PSA] concentration attained likelihood ratios formally required for a screening test." The study stated overdiagnosis of cancer may be as high as 50%

The only thing the study could ascertain as having any meaning is a PSA result of less than 1.0 ng/ml, which rules out any potential for a follow-up diagnosis of prostate cancer. In other words, if the result is particularly low, there is no prostate cancer. That's all the test can reliably diagnose. A higher PSA result has little relationship to the existence of cancer. It may be there. It may not. Only further testing—invasive testing—can find out whether cancer does or doesn't exist.

As a rule, doctors order further testing for PSA results over 4.0 ng/ml. However, more than half of all lethal prostate cancers exist in men with PSAs under 4.0.

As I've pointed out before, most men die with prostate cancer. That sounds terrible—but note that I didn't say, "die of prostate cancer." This leads to a salient question: What is the benefit of finding most prostate cancers, when most of them don't cause any harm? Especially when results interpreted as meaning there might be cancer are usually followed by a great deal of stress and further that, as is now well documented, profit no one but doctors' and laboratories' bottom lines?

How many unnecessary prostate surgeries, with resultant impotence, happen because of these tests? How many cancers that wouldn't have metastasized do because they've been pierced by biopsies? How many men suffer from the misery and immune system damage of chemotherapy for cancer that would never have caused a problem? How many men become incontinent and impotent?

In the US, the PSA test is heavily pushed; it's generally recommended that all men over 50 have it done annually, and some men are pressed to start having it at age 40. All of this is done, at tremendous cost to the medical system, while the National Cancer Institute notes that, "...only 25 to 35 percent of men who have a biopsy due to an elevated PSA level actually have prostate cancer."

In the UK, routine PSA testing isn't done. NICE has wisely determined that it makes no fiscal or health sense. There are, though, significant efforts to press annual PSA testing, most notably by the Prostate Cancer Support Federation and Prostate UK, which have produced Prostate Cancer Risk Management Programme A guide for GPs and men seeking a PSA test (PDF), which advocates a right to annual PSA testing for any man over 50. One must wonder if they're paying attention to the studies that demonstrate the inffectiveness and harm of these tests.

The PSA test was never intended to screen for cancer. A member of the UK's scientific advisory group, GP James Kingsland, stated, "It is using a test for something which it was never designed for, which is always dangerous." Its purpose was to track existing prostate cancer's progress.

As ever, profits have driven medical testing and treatment. PSA testing's results, as with mammograms—though nowhere near as harmful, as it doesn't cause the disease for which it's testing—are far from accurate, cause untold stress, and leave a trail of pain and worse health behind the profits.