SCREENING men for prostate-specific antigen, the most commonly used tool for detecting prostate cancer, has become expensive and disastrous.

Richard Ablin, the researcher who discovered prostate-specific antigen in 1970, expressed his views in a opinion piece entitled The Great Prostate Mistake, published in the New York Times, recently.

Prostate-specific antigen is a protein produced by cells of the prostate gland. The test measures the level of prostate-specific antigen in the blood. A doctor takes a blood sample and the amount of prostate-specific antigen is measured in a laboratory.

Because prostate-specific antigen is produced by the body and can be used to detect disease, it is sometimes called a biological marker or a tumor marker.

It is normal for men to have a low level of prostate-specific antigen in their blood; however, prostate cancer or benign (not cancerous) conditions can increase a man’s prostate-specific antigen level.

As men age, benign prostate conditions and prostate cancer become more common.

The most frequent benign prostate conditions are inflammation of the prostate and benign enlargement of the prostate. A man’s prostate-specific antigen level alone does not give doctors enough information to distinguish between benign prostate conditions and cancer.

However, a doctor takes the result of the PSA test into account when deciding whether to check further for signs of prostate cancer.

The annual bill for prostate-specific antigen screening in the US is at least $3b. But the test is “hardly more effective than a coin toss,” he writes.

“It’s amazing to see the physician who discovered prostate-specific antigen takes such a strong stance against it,” says Elizabeth Whelan, from the American Council on Science and Health.

Prostate-specific antigen screening is recognised as being an imperfect tool and there is continuing ongoing debate about how best to use it.

“Prostate-specific antigen testing can’t detect prostate cancer.” He points out that infections, over-the-counter drugs like ibuprofen, and benign swelling of the prostate can elevate the antigen levels.

The test cannot differentiate between prostate cancer that is rapidly growing and potentially fatal from one that is growing slowly and will not kill.

Prostate-specific antigen screening should absolutely not be deployed to screen the entire population of men over the age of 50.

The test can be used to follow patients who have had treatment for prostate cancer, where a rapidly rising score indicates a return of the disease.

Drug companies continue peddling the tests and advocacy groups push prostate cancer awareness by encouraging men to get screened,” he asserts.

“The medical community must confront reality and stop the inappropriate use of prostate-specific antigen screening,” he states.

“Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatment.”
There are already some signs of changing attitudes.

Two huge studies published last year showed that prostate-specific antigen screening had either no or little effect on the death rate from prostate cancer.

These and other data have led to the realisation that many men diagnosed with prostate-specific antigen screening are being overtreated.

The medical community is “slowly turning against prostate-specific antigen testing,” Ablin says.

In a recent interview with Medscape Oncology, the spokesperson of The American Urological Association, Brantley Thrasher, said test results should not be considered on their own, but need to be interpreted along with other information.

“I don’t want people to walk away from prostate-specific antigen and say it’s useless. “Prostate-specific antigen does not work well by itself in predicting prostate cancer,” Thrasher said. “We we are still saving lives with the test.”

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