Screening For Prostate Cancer

A 60-year-old man presents to your office inquiring about prostate cancer screening. Choose the correct statement:

A) PSA is the gold standard test for prostate cancer screening.
B) PSA should be checked annually starting at 50 years of age to screen for prostate cancer.
C) PSA can produce false-positive results, which can be associated with negative psychological effects.
D) Men who have false-positive test are less likely to have additional testing.
E) The USPSTF recommends PSA testing to screen for prostate cancer at age 60.

Answer And Discussion:

The answer is C. (PSA can produce false-positive results, which can be associated with negative psychological effects)

Convincing evidence demonstrates that the PSA test often produces false-positive results; approximately 80 percent of positive PSA test results are false-positive when cutoffs between 2.5 and 4.0 ng per mL (2.5 and 4.0 μg per L) are used. There is adequate evidence that falsepositive PSA test results are associated with negative psychological effects, including persistent worry about prostate cancer.
Men who have a falsepositive test result are more likely to have additional testing, including one
or more biopsies, in the following year than those who have a negative test result.

There is also convincing evidence that a substantial percentage of men who have asymptomatic cancer detected by PSA screening have a tumor that either will not progress or will progress so slowly that it would have remained asymptomatic for the man’s lifetime.

Although the precise, long-term effect of PSA screening on prostate cancer–specific mortality remains uncertain, existing studies adequately demonstrate that the reduction in prostate cancer mortality after 10 to 14 years is, at most, very small, even for men in what seems to be the optimal
age range of 55 to 69 years.

There is no apparent reduction in all-cause mortality. In contrast, the harms associated with the diagnosis and treatment of screen-detected cancer are common, occur early, often persist, and
include a small but real risk of premature death.