PSA test under fire

The early screening test for prostate cancer, the Prostate Specific Antigen (PSA) test, has come under fire in recent weeks. A new study in the USA has shown that radical prostatectomy, or prostate cancer surgery, does not significantly increase the chances of survival in men diagnosed with prostate cancer.

The study tracked 731 men with prostate cancer over 12 years to see how removing the prostate compared with continuing observation in terms of survival rate. After 10 years 5.8 per cent of men who had received surgery had died, compared to 8.4 per cent of those who had not undergone surgery.

Although the men who underwent surgery had a slightly higher survival rate, they also had a much higher chance of developing negative side effects. Two years on from a radical prostatectomy 81 per cent of patients had developed erectile dysfunction, 17 per cent had urinary incontinence and 12 per cent had bowel dysfunction.

In contrast, after two years of observation only 44 per cent of men who had not undergone surgery had erectile dysfunction, 6 per cent were suffering urinary incontinence and 11 per cent had some level of bowel dysfunction.

Scientists and doctors are suggesting that the increased survival rate of men who undergo a radical prostatectomy may not make up for the life-altering side effects. They suggested that a positive result on the PSA test may prompt men to undergo unnecessary surgery for less aggressive forms of prostate cancer. They cautioned, however, that regular PSA testing in men over 50 was still likely to help those diagnosed with aggressive prostate cancer, as early diagnosis is still the best way of increasing survival in these men.

In response to those calling for an end to PSA testing Associate Professor Declan Murphy, a urological surgeon at the Peter MacCallum Cancer Centre, has reminded people that before PSA testing was introduced the chances of men surviving five years beyond being diagnosed with prostate cancer was less than 50 per cent. Now more than 90 per cent of men are alive more than five years after diagnosis.

Whether you are considering getting a PSA test or you are already being tested regularly, any health concerns or changes to your testing should be discussed with your GP or specialist.

To find out more about this research read Neil Mitchell’s interview with Associate Professor Ian Haines.