Risks of PSA Testing

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PSA test results are interpreted as: 0-4 ng/mL is normal. Between 4 to 10 ng/ML is 25% of developing cancer, and > 10 ng/ml is a > 50% risk of cancer. However, some men with normal PSA levels still have prostate cancer, while other men with high PSA levels do not. PSA levels increase with age often due to a higher prevalence of benign prostate hypertrophy (BPH). Therefore, no PSA cutoff can accurately guarantee that a man does not have prostate cancer.
PSA blood levels are used for several different purposes such as to diagnose prostate cancer, evaluate treatment of prostate cancer, and to evaluate the severity of benign prostatic hyperplasia (BPH). Currently there is no way to determine between prostate cancers that is aggressive verse mild cases. When screening identifies cases that is not life threatening men may experience unnecessary worry and complication to include urinary incontinence, erectile dysfunction, and psychological problems.
One out of every five in 1000 men who are treated surgically will die within one month of the surgery. In addition between 10 and 70 of these men will have serious complications from surgery. Many others treated with radiotherapy or surgery 200-300 in 1000 will suffer long-term problems that include urinary incontinence, erectile dysfunction and bowel problems. The PSA screening test often produces false positive results, which leads to psychological effects and other adverse effects associated with biopsy such as infection, pain and bleeding as well as more unnecessary testing. (Chou et al., 2011). (Are all these statistics from chou?)
However, The American Urological Association along with the ACS believe that PSA-based screening and early treatment for prostate cancers are still essen...

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...rgery) cause many serious complications and even death. As a result, the USPSF recommends against the use of PSA based screening test for men of all ages. However, the PSA based screening test an associated treatments of early-detected prostate cancers should be applied only to men who may benefit from early detection and related treatments. In addition to decrease complications and improved treatment effectiveness, PCa treatments should be performed at high volume centers for better control and follow up. We can only hope that future advances will provide a screening test that can better predict prognosis as well as diagnosis and will provide modes of treatment that result in less morbidity and decreased mortality rates.

References
American Cancer Society (2013). http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-survival rates.

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