A new study, reviewing and pooling results from prior studies in prostate cancer screening, shows that screening men for prostate cancer does not increase life expectancy.
While the PSA test is effective at predicting which men may eventually get prostate cancer, it is ineffective in increasing life expectancy. This is because most men with a high PSA will not get prostate cancer in their lifetimes and will eventually die from something else. Many men, some of whom I have debated the value of a PSA test with, get a high PSA test result and live in fear of cancer for decades, even though prostate cancer never develops. Further, prostate cancer treatments, including surgery or radiation, can lead to incontinence and erectile dysfunction in about a third of patients. Unfortunately, some men get the treatments after a high PSA from fear of cancer which may never reach them in their lifetime. Other men get the treatments when they contract prostate cancer, even though this slow-growing tumor will not hurt them in their lifetimes. It is a case where the cure is sometimes worse than the cause.
The study is part of an effort to streamline which medical tests are effective, not just in detecting disease or the potential for disease, but for actually increasing life expectancy and increasing quality of life. A similar effort was undertaken to critically and empirically view breast cancer screening. The breast cancer screening recommendations were met with a flurry of criticism. Hopefully, this recommendation will not meet the same result.