PSA screening data suggest nuanced approach

From the 2012 Department of Surgery Annual Report

AR_AndrioleSince performing the large-scale clinical trials that launched the prostate specific antigen (PSA) test into clinical practice in the 1990s, Washington University urologists led by Gerald Andriole, MD, have continued refining its use.The U.S. Preventive Services Task Force recommendations against routine PSA testing for healthy men age 50 and older drew spirited opposition among many urologists and advocates for those with prostate cancer. Washington University Chief of Urologic Surgery Gerald Andriole Jr., MD — a leading expert in prostate cancer screening — believes it would be a mistake to universally dismiss the screening test and argues men are best served with a more nuanced approach.

Andriole acknowledges that widespread testing has led many men with slow-growing tumors to be over diagnosed and over treated with aggressive therapies. For these men, who are unlikely to die from their prostate cancer, the cost and side effects of biopsies and treatments outweigh the benefits of PSA testing.

“If you screened all men, since only about three out of 100 are going to die of prostate cancer, there are only three men who would potentially benefit and 97 who could potentially be harmed,” says Andriole. “On the other hand, if you screen only men who are at higher risk for dying of prostate cancer — about 10 to 15 percent — there is a greater percentage of men who stand to benefit and commensurately fewer who stand to be harmed.”

In the journal European Urology, Andriole and other scientists advocated a risk-based approach that would encourage PSA testing for African-American men, the ethnic group at highest risk for prostate cancer; men with a strong family history of prostate cancer; and those with additional risk factors related to age, other illnesses, prostate volume and previous biopsy status.

Andriole, the Robert K. Royce Distinguished Professor of Urologic Surgery, has played a key role in developing prostate cancer screening guidelines as chairman of the prostate committee for the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Trial.

This major national study has found that annual prostate cancer screening does not reduce deaths from the disease, even among men in their 50s and 60s and those with underlying health conditions. The first systematic evaluation of the PSA test was conducted by Washington University urologists more than 20 years ago. Since then, the division’s urologists have continued to evaluate use of the test.