Value of PSA screening test questioned

The test represents a significant decision dilemma for both patients and physicians. Some physicians believe it should be an annual ritual. Others aren't so sure.

By Victoria Stagg Elliott, AMNews staff. Oct. 11, 2004.

G. Stephen Nace, MD, a general internist in Peoria, Ill., often ends up talking prostate-specific test results on Sundays after church. Men from the congregation come up to him and tell him their most recent scores from this common prostate cancer screening method.

"Guys talk about it," said the assistant professor of clinical medicine at the University of Illinois College of Medicine. "But I don't think many patients really appreciate the depth of the question and the issues involved. For most patients, it's just a blood test."

The test is one of the more controversial in medical circles, and this month, even one of the researchers who carried out much of the groundbreaking work to create it questioned whether it should be used at all.

"The PSA era is over in the United States," said Thomas Stamey, MD, professor of urology at Stanford University School of Medicine and lead author on the landmark paper in the Oct. 8, 1987, New England Journal of Medicine suggesting that rising PSA levels could be useful to detect and monitor prostate cancer.

Dr. Stamey's declaration came as part of his more recent paper published in the October Journal of Urology that offered a very different conclusion. In this study, he and his team analyzed tumors from more than 1,000 radical prostatectomies over the past 20 years. They determined that PSA testing was discovering smaller and smaller tumors that were less likely to be deadly. Thus, the conclusion: PSA levels are more indicative of whether the prostate is enlarged than if it is cancerous and needs to be treated.