Did the Decline in PSA Causes Cases of Advanced Prostate Cancer?
A large new study of U.S. veterans suggests that when prostate cancer screening (PSA) rates go down, the number of men diagnosed with advanced cancer then rises.
Researchers found that across 128 U.S. veterans health centers, the rate of PSA screening for prostate cancer declined between 2008 and 2019 — a period where guidelines came out recommending against routine screening.
But patterns varied among the individual centers, with some maintaining high screening rates.
And in subsequent years, the study found, a trend emerged: VA centers with higher PSA screening rates had fewer cases of metastatic prostate cancer, while more cases were diagnosed at centers with lower screening rates.
Metastatic refers to prostate cancers that have spread to distant sites in the body and cannot be cured.
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Should you be screened for prostate cancer?
According to experts, the findings do not mean that all men at average risk of prostate cancer should be routinely screened for the disease.
But the results do add to a longstanding debate over the issue.
Prostate cancer is highly prevalent: About 1 in 8 men will be diagnosed with the disease in their lifetime, according to the American Cancer Society. But the cancer is often slow-growing, and may never progress to the point of threatening a man’s life: About 1 in every 41 men actually dies of the disease.
That’s why routine screening — with blood tests that measure a protein called PSA — has been controversial. The main concern is that it may often detect small tumors that would never have become harmful — leading to “over-treatment” that exposes men to the risks of side effects such as incontinence and erectile dysfunction.
Adding to that, two major trials published about a decade ago came to conflicting conclusions about