Get past the rhetoric and the data seem reasonably clear: PSA testing leads to the earlier diagnosis of more prostate cancer and probably reduces deaths related to that disease. However, the non-financial cost of this testing is that thousands of men become incontinent and impotent from surgery to remove a slow-growing cancer that would never have bothered them.
The problem is that there isn't a right answer that applies to every man: The right answer depends on who you ask, and the only relevant person to ask is the man getting the test.
Some men find it intolerable to live with the idea that they might be harboring a silent prostate cancer in their pelvis. Their quality of life will be seriously diminished by the uncertainty. These men may be good candidates for PSA screening.
Other men may find it unacceptable to undergo surgery or radiation that might leave them impotent or incontinent. They would rather take the risk of dying of prostate cancer. These men should definitely not have PSA screening.
How do men decide which group they are in? Try talking to them and empowering them with evidence.
In my field -- obstetrics -- we do this all the time, because the test we have to screen for Down syndrome and other genetic abnormalities isn't perfect. It doesn't say "positive Down syndrome" or "negative Down syndrome," it says "high risk" or "low-risk." Women have to decide whether to have the test at all, and if they have it, what they will do with the results. We have genetic counselors whose job it is to meet with women for up to an hour just to discuss these tests, how they work, what the results will look like, and what women will do with the different potential future results. We empower women to make the best decision for them.
Men should be empowered to make the best decision about PSA testing for them, and the answer isn't a dictum -- it's information and education.
If your doctor isn't empowering you with information, it's time to find a new doctor.
Follow Adam Wolfberg, M.D. on Twitter: www.twitter.com/AdamWolfberg