PSA Testing for Every Man Over 40? No Way!

Once again, another large study — 13 years, involving nearly 77,000 men — shows that medical interventions can cause more harm than good.

The study looked at death rates among men who received annual PSA screening for prostate cancer and men who didn't. It found that men who had annual screenings were actually more likely to die of prostate cancer! Not the desired result, of course — the test is intended to prevent death.

And the fact that more men died doesn't even take into account the enormous financial, physical and emotional suffering caused by medical interventions after positive PSA tests — interventions that research shows are often unnecessary, because these tests detect small, slow-growing, non-threatening cancers.

In response to the study, one cancer doc told the media, "Routine mass screening of the population, purely on the basis of a man's age, is not going to be an effective way of reducing his chance of dying of prostate cancer." I couldn't agree more, though PSA screening may be a good idea if you have a strong family history of the disease, or if you're African-American (African-American men have a higher-than-average risk of prostate cancer).

Bottom line: more and more evidence suggests that adults who feel well do best if they stay away from doctors, except for some basic screening tests. These tests include:

• Blood pressure, yearly after age 40 (these days, many pharmacies have free blood pressure machines that check your reading).
• Diabetes screening, over the age of 50 — depending on yourother risk factors for diabetes, such as being overweight. (It would be good if pharmacies offered simple blood sugar tests, along with blood pressure.)
• Colonoscopy, every 10 years, beginning at age 50.
• Mammography, possibly yearly from the age of 50 to 60 — if you have a strong family history of breast cancer.
• Testosterone levels in men with symptoms of low testosterone (e.g., fatigue, depression, hypertension, high cholesterol, diabetes, or erectile dysfunction). In those on testosterone therapy, it may be reasonable to check a PSA.

References

"Prostate cancer screening in the randomized Prostate, Lung, Colorectal, and Ovarian cancer screening trial: Mortality results after 13 years of follow-up." Andriole GL et al, Journal of the National Cancer Institute, 2012; 104: 125-132.