This is a follow-up to a post I wrote called, “PSA Testing: The Good, the Bad and the Ugly”. http://prostatecancerblog.net/wp-admin/post.php?action=edit&post=2120. Please read that before you read this.
Dr. Richard Ablin, father of the PSA test, argued in a New York Times op-ed piece recently that the widespread, routine use of the test to screen for prostate cancer (PC, my abbr.) has been nothing short of a “costly, profit-driven public health disaster”.
While I agree with much of what Dr. Ablin says, I think he overstates his case. Take for example the argument that widespread, routine PSA screening is not worthwhile because only 3% of men with prostate cancer (PC) actually die of the disease. I find this point of view myopic . It ignores the suffering and disability endured by the many men who live with prostate cancer for years and may endure harsh treatments, even though they may be “lucky enough” to eventually die with PC, not of it. (Keep in mind that there are about four million men in this country who have been diagnosed with PC. ) And let’s not forget the 30,000 men who do die of PC each year.
So I say it’s not just quantity but quality.
And the PSA test is not quite as useless as Dr. Ablin makes it out to be. If that were so, then why would the doc recommend that high-risk patients be tested? The value of the PSA test is much greater when combined with other patient risk factors such as age, Gleason score, stage, PSA density, etc. And the new PCA3 test, which is more “specific” for PC (no false positives), can also give the PSA test a boost when the two are combined. (The test is not yet FDA-approved but used by some clinicians.)
Also, PSA levels in