Invited Commentary
July 26, 2010

The Cautionary Tale of PSA TestingComment on “Risk Profiles and Treatment Patterns Among Men Diagnosed as Having Prostate Cancer and a Prostate-Specific Antigen Level Below 4.0 ng/mL”

Author Affiliations

Author Affiliations: Medicine Service, New Mexico VA Health Care System, and University of New Mexico School of Medicine, Albuquerque (Dr Hoffman); Health Services Research & Development Center of Excellence, VA Puget Sound Health Care System, and Department of Health Services, University of Washington, Seattle (Dr Zeliadt).


Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Intern Med. 2010;170(14):1262-1263. doi:10.1001/archinternmed.2010.222

The initial promise of PSA screening was that a simple, accurate blood test would save lives by detecting tumors at an early enough stage to be cured by aggressive treatment. Unfortunately, some 2 decades into the PSA era, the promise of early detection has been tarnished. In the United States, widespread PSA testing led to a higher incidence of early-stage disease, creating an epidemic of prostate cancer in which the lifetime risk of diagnosis increased from 9% to 16%.1 However, a substantial proportion of these PSA-detected cancers likely never would have been found in the absence of screening.2 Nevertheless, as Shao and colleagues highlight, even the lowest-risk tumors are often treated aggressively. These findings lead to the disconcerting realization that an important legacy of the PSA era might be the overdiagnosis and overtreatment of low-risk cancers. Herein, we address the potential harms from PSA testing and the implications for clinical practice.

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