I had my annual physical yesterday, and my doctor and I were discussing whether it is worthwhile to have a PSA test. (My previous test results, as late as last year, were very low.) As I understand things, the test is not proven to be determinative of anything. So, even if the value goes up dramatically, it is not necessarily a sign of cancer. It might, for example, be a noncancerous condition like BPH. The test can also produce false negatives, i.e., an indication that all is well when cancer is in fact present.
As noted here, by the man who invented the test:
[Richard J.] Ablin has been frustrated by the widespread use of the test. Each year, he notes, some 30 million men undergo PSA testing, at a cost of $30 Billion. Yet “the test is hardly more effective than a coin toss. As I’ve been trying to make clear for many years now, P.S.A. testing can’t detect prostate cancer and, more important, it can’t distinguish between the two types of prostate cancer — the one that will kill you and the one that won’t. “
He acknowledges that “Prostate-specific antigen testing does have a place. After treatment for prostate cancer, for instance, a rapidly rising score indicates a return of the disease. And men with a family history of prostate cancer should probably get tested regularly. If their score starts skyrocketing, it could mean cancer. But these uses are limited. Testing should absolutely not be deployed to screen the entire population of men over the age of 50, the outcome pushed by those who stand to profit.”
Gary Schwitzer quotes from the American Cancer Society website:
"The American Cancer Society recommends that men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the uncertainties, risks, and potential benefits of prostate cancer screening. Men should not be screened unless they have received this information."
So, there we have it. Should I cause scarce health care dollars to be spent on a test that will not give me useful information? Or, to put it another way, why go through the potential stress of a higher number if it is not necessarily indicative of a problem? Or should I cause these dollars to be spent so, if the number remains low, I have a false sense of security?