Since PSA testing began, the apparent incidence of prostate cancer has doubled in the United States. It's not that the cancer rate is increasing, it's just that we are detecting more cancer. But better detection has not resulted in more cures. The mortality rate among prostate patients has not decreased at all. And small elevations in PSA levels have become a gold mine for urologists, resulting in thousands of unnecessary biopsies and treatment programs each year.
Some scientists believe that PSA screening may be unable to detect prostate cancer because more men who were screened died from prostate cancer compared with those who were not. The conclusion is controversial because it is based on an original research paper which had suggested that PSA screening could reduce death from prostate cancer by 69%. But some experts to whom the paper was presented said the research was flawed.
Only 23% of the men invited to join the screening program actually did so, but the researchers had not allowed for this. In addition, 982 of the 8,137 men in the screening group had been placed in the unscreened control group. When the data was reanalysed, the death rate among the screened group was higher, said Peter Boyle from the European Institute of Oncology in Milan. [Lancet, 1998; 351:1563]
The Problem
PSA levels are only a guideline. About 75% of men with prostate cancer have correspondingly elevated levels of PSA (the cancer may be too small to increase PSA levels).
When PSA levels approach 10.0, there's about a 50% chance of finding prostate cancer. At that level the cancer will generally be confined to the prostate gland. Even when PSA levels are between 10.0 and 20.0, cancer is not always present. However, when it does exist at these PSA levels, cancer is more likely to have spread to the lymph nodes.
Also keep in mind that a slow-growing prostate cancer may not require any treatment, whereas a fast-growing cancer may need more aggressive treatment.
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