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PSA Testing for Prostate Cancer in Asymptomatic Men: Information for Health Practitioners submission

ID: 
4
Personal Details
First Name: 
Ian
Last Name: 
Arthur
Specific Questions
1. What are the potential benefits of PSA testing?: 

In theory the Euopean study showed that if 1600 men were screened for prostate cancer one life could be saved. The American study showed no benefit and if fact there was a higher mortality, but not statistically significant mortality in those men screened for prostate cancer. Therefore the only benefit of PSA testing is that  it increases the income of pathology companies, urologists,oncologists and pharmaceutical companies that treat prostate cancer.

2. What are the potential harms of PSA testing?: 

About 50 % of men treated for prostate cancer beome incontinent , impotent or both.  5 in 1000 men die of post operative complications.About 1 to 3 % of men who have a prostate biopsy develop infections.  15% of men who are treated with radiotherapy develop chronic diarrhoea.

3. How frequent are these benefits and harms?: 

See note above. This is well known and well-documented.

4. What research has been done to study the effectiveness of PSA testing for prostate cancer?: 

There was a big study of 250,000 men in Europe and the USA over a 20 year period. These are well known studies.

5. Does PSA testing in asymptomatic men reduce their risk of dying from prostate cancer?: 

The European study says 1 in 1600 men benefit. The american study shows no benefit.

6. Does PSA testing in asymptomatic men reduce their overall risk of dying?: 

No

7. Does PSA testing in asymptomatic men reduce their risk of having metastases present at diagnosis of prostate cancer?: 

No

8. Does PSA testing in asymptomatic men affect the quality of life of men who are diagnosed with prostate cancer?: 

Yes . There are significant psychological stressors associated withliving with cancer and living with incontinence and impotence.

9. What is a PSA test?: 

Prostatic Specific antigen is a blood test.

10. How accurate is a PSA test?: 

It can vary from one test to anoather by 50 %

11. Are there any other screening tests available for prostate cancer?: 

Digital rectal exam

12. How can men prepare for a PSA test?: 

No preparation is needed. They could read information from their GP

13. What are normal and abnormal PSA test results?: 

This depends on the age of the patient

14. What happens if a man receives a normal PSA test result?: 

He is reassured his chance of developing prostate cancer in the next 1 year or 5 years is low.

15. What happens if a man receives an abnormal PSA test result?: 

He can opt ot repeat the test or see  urologist

16. If a man receives a diagnosis of prostate cancer after an abnormal PSA test, what choices does he have?: 

Watch and see. Treatment by radiotherapy, surgery or hormone therapy

17. If a man decides not to have a PSA test what risks should he and his family be aware of?: 

He may die sooner of prostate cancer than if he had treatment

General Comments
18. Considering the Information Document is for Health Practitioners, do you have any other comments?: 

There seems to a fear that if the person is not tested they may be sued. Doctors do not seem to understand the risks of overtreatment and overdiagnosis. It is tempting to just order a PSA rather than spend 20 minutes discussing the pros and cons of doing a test. There is pressure form patients to have " the little prick". Two thirds of patients are pressured by their wives to have a PSA test.

It seems counter intuitive to doctors not to order a test. No one ever got sued for not ordering a test. There needs to a really stong document from the NHMRC outlining the negatives of testing. There should be a law enforcing disclosure of the origin of funding for promoting a PSA test.

There should be widespread publicity of the cost of treating prostate cancer and investigating cancer and how this money could be better spent.

PSA testing is the most harmful and wasteful test ever invented. It is only useful for monitoring response to treatment and investigation of symptoms suspicious of prostate cancer.

 

Page reviewed: 4 March, 2014