Studies Find PSA Screening Unreliable

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Holmstrom advised men to discuss with their doctor whether or not they should have a PSA test.

In a second report, Jennifer Stark, a research fellow at Harvard School of Public Health in Boston, agreed that "before PSA testing is performed, men should be thoroughly informed about the PSA test itself and the fact that the test cannot tell whether they have a life-threatening cancer."

In that analysis, Stark and her colleagues found the data on costs and benefits remain insufficient to support population-based PSA screening for prostate cancer.

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"PSA levels increase not only during cancer development, but also in some benign conditions, and PSA cannot differentiate between indolent and lethal prostate cancer," Stark said.

"We know these limitations lead to false-positive results, overdiagnosis and overtreatment, but the psychological and financial costs of PSA testing for the early detection of prostate cancer have not yet been measured precisely enough to determine if they outweigh a modest benefit in survival associated with screening," she said.

Although most agencies providing recommendations on prostate cancer screening, especially those outside the United States, do not recommend routine PSA testing for the early detection of prostate cancer, it continues to be performed frequently, Stark noted.

"While it is not completely clear whether the tests are more often initiated by patient or provider, data suggest that men are often not informed about the limitations of the test and about the need to interpret the results of a positive or negative test result with those limitations in mind," she said.

Dr. Dragan Ilic, a senior lecturer at Monash Institute of Health Services Research at Monash University in Australia, and author of an accompanying journal editorial, said the data about the value of PSA tests remains confusing.

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