Prostate cancer is a common disease that causes symptoms in many men. Prostate specific antigen (PSA) testing can help doctors diagnose prostate cancer. The test measures the amount of PSA in a man’s urine. It can be a useful tool in diagnosing cancer, but it has not been shown to reduce deaths from prostate cancer. In addition, it is associated with some harms. These include pain, urinary tract infections, and erectile problems. Screening can also result in a false-positive test (a test that shows there is cancer when there isn’t) and a biopsy. Biopsies can be painful, and they have risks of complications including infection, blood in the urine or sperm, and temporary erectile problems.
In a study, investigators from Weill Cornell Medicine, Fred Hutchinson Cancer Center, University Hospitals Cleveland and Case Western Reserve University, and other institutions looked at data on prostate cancer screening from the national fee-for-service Medicare program. They found that the annual cost of prostate cancer screening varied by location but was generally about $447 million per year. This includes the costs of tests and follow-up procedures such as a prostate biopsy. Some of the highest costs are for MRI scanning, which helps doctors determine whether there is a suspicious area in the prostate that should be biopsied.
Some prostate cancers never cause any symptoms or death, but they are found by screening tests. These cancers are called overdiagnosis. Overdiagnosis can lead to overtreatment, which may be harmful. For example, radical prostatectomy and radiation therapy can cause long-term side effects including erectile dysfunction and urinary incontinence.
Men who are at higher risk of prostate cancer should talk to their health care provider before deciding whether to be screened. This includes African American men and men who have a first-degree relative with prostate cancer diagnosed at an early age. Men should discuss their overall health and family history with a health care provider to determine the balance of benefits and harms.
In addition to age, the USPSTF considers a person’s family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs in making a decision about screening. Men who choose to be screened should receive information about the benefits and harms of PSA screening, so they can make an informed choice.
There are approaches to screening that might increase the potential benefit — such as more frequent testing and lower thresholds for biopsy. However, these approaches might also lead to more false-positive results and more biopsies, which have significant harms. New technologies are being developed to better distinguish between high-risk and low-risk prostate cancers, which may help to reduce overdiagnosis and overtreatment. These technologies could be used with current screening tests or as stand-alone tests. PCF is funding research to develop these new technologies. For more information about PDQ cancer information summaries, see the PDQ Prostate Cancer page.
