Four flawed arguments against prostate-specific antigen screening (and 1 good one).

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• Prostate-specific antigen (PSA) testing for prostate cancer screening is a subject of ongoing debate.
• Several arguments have been raised questioning the validity and utility of PSA screening.
• The European Randomized Study of Screening for Prostate Cancer (ERSPC) is a key trial in this discussion.

Purpose of the Study:

• To critically evaluate common arguments against prostate cancer screening using PSA testing.
• To identify valid concerns regarding the current practice of PSA screening and its associated treatments.
• To propose a path forward for the urology community to optimize PSA screening outcomes.

Main Methods:

• Personal reflection and review of existing arguments and data concerning PSA screening.
• Analysis of the validity of four common criticisms of PSA screening and the ERSPC trial.
• Examination of the fifth argument concerning the balance of benefits and harms in current PSA screening practices.

Main Results:

• Four prominent arguments against PSA screening, including criticisms of the ERSPC trial, mortality benefits, and PSA test accuracy, were found to be invalid.
• A valid criticism exists regarding current PSA screening practices, which may lead to more harm than good.
• Issues identified include screening older men, overtreatment of low-risk cancers, undertreatment of high-risk cancers, and treatment at low-volume centers.

Conclusions:

• While many criticisms of PSA screening are unfounded, current practices require significant improvement.
• The urology community must become more judicious in screening, biopsy, and treatment decisions.
• Referral to high-volume institutions and ensuring screening provides more benefit than harm are crucial for the future of prostate cancer detection.