PSA screening

PSA screening

by Samuel Dafydd Rigby -
Number of replies: 4

The UK national screening committee defines screening as "The process of identifying apparently healthy people who may be at increased risk of a disease or condition"

For this seminar I have chosen to consider PSA screening for Prostate cancer. Those who have no symptoms have blood tests to measure PSA levels to understand that persons likelihood of having Prostate cancer. The is significant debate regarding the validity of using this screening technique.

Pro's

- Many cancers have been caught before metastasising due to screening.

- Many men have been put at ease regarding this relatively common male cancer on recieving negative results

Con's -

- Takes time

-artificially promotes concern from invitiation to screening to results (even after results if positive)

- False positives are common, provoking avoidable damage in further investigation

- may cause many to live longer under 'diseased' label with no improval in mortality owing to lead-time bias of screening.

 

Groups may advocate screening because it may have saved someone close to them, some may feel we have access to this technology so we should use it. Others may feel they can profit from such screening programmes. Others still may feel it is a good impetus for people to visit medical professionals for general review.

 

Those opposing may see large amounts of money as wasted, people being put in unecessary distress, unecessary further investigation and treatment, profiteering, medicalisation of normal healthy people, premature disease status labelling.

These beliefs are enacted through lobbying, protests and avoidance of screening programmes (or even medical contact)

 

Paper of PSA screening : http://www.sciencedirect.com/science/article/pii/S0302283812007610

In reply to Samuel Dafydd Rigby

Re: PSA screening

by Sandeep Suryadevara Rao -

I think it was mentioned in the Natalie Armstrong paper that there are pro-PSA lobby groups in the USA, encouraging the use of such a screening test, despite a lack of great clinical benefit. Epidemiologically, prostate cancer is a disease of old men. Generally, an elderly man who only has prostate cancer on his list of medical problems is more likely to be from a higher socio-economic group. So it could be that political pressure to continue PSA screening comes from rich, old men who want to live forever (wheras to benefit the overall population the money could be better spent elsewhere)

As you mention, the personal knowledge of someone with prostate cancer may make people more likely to advocate its usage: given the high prevalence and low mortality attributed to prostate cancer we probably all know somebody with it. When I sit in my dad's local pub, his two friends with prostate cancer compare their PSA levels to try to figure out who is 'healthier'. What to be people make of this?

In reply to Sandeep Suryadevara Rao

Re: PSA screening

by Storm Parker -

Interesting Sandeep about your dad's friends in the pub- I wonder if they are using their PSA levels as a marker for their general health-  even though these men have positive test results (as in high PSA levels), they are possibly still using it as a security blanket, is this a good or a bad thing?

Ahmed- I guess the question of whether it is worth putting people at risk of a false positive for the benefit of those who are saved by a true negative depends on peoples perceptions of risk. For example, an adverse effect of prostate cancer treatment could be erectile dysfunction of urinary incontience- who is to decide if this is better/worse than the risk of prostate cancer itself? Is a patient capable of understand the risk of each and then comparing these to come to a decision?

In reply to Sandeep Suryadevara Rao

Re: PSA screening

by Deleted user -

At the seminar held yesterday at Michael Mason, the professor mentioned one of the problems men who go for prostrate cancer screening may encounter after the screening is that they may not be able to pee as well as they used to after the test. Unfortunately, unlike women who have commerical products to help them with troubles with discharge, the men in the UK lack this. I suppose that is not a major negative against prostrate cancer screening in the grand scheme of things, but consider the discomfort of having to pee on yourself all the time just because you went for a test when nothing was actually wrong with you. It would be easily to live with if you viewed it as little price to pay for something that is saving your life. 

In reply to Samuel Dafydd Rigby

Re: PSA screening

by Ahmed Al-Nowfal -

I think with movember prostate cancer is a very interesting one, it is the second largest cause of cancer death in men in the uk but More than 80% of men will develop prostate cancer by the age of 80. The  majority of cases, it will be slow-growing and harmlesss. So wont this screening carry the trend of overdiagnosing? Or is trying to prevent the 10000 deaths in the uk be worthy of putting so many others in unnecessary procedures/ treatment?