What Are the Benefits and Harms of Screening?

The U.S. Preventive Services Task Force (USPSTF) is an organization made up of doctors and disease experts who look at research on the best way to prevent diseases and make recommendations on how doctors can help patients avoid diseases or find them early. The USPSTF recommends that men do not get a prostate specific antigen (PSA) blood test to screen for prostate cancer. Every screening test has benefits and risks, and the USPSTF says that the risks of PSA testing tend to outweigh the potential benefits.

Most prostate cancers found by screening are small and slow-growing, and may not cause problems at all over a man’s lifetime. Some men screened with a PSA test will have the test show that they have prostate cancer when they really don’t, which is called a false positive. Doctors may want to check to see if there really is cancer, so they may do a test called a biopsy to remove a sample of prostate cells or tissue for a pathologist to look at under a microscope. A biopsy can cause infection, pain, and bleeding, and the test may not show that there is cancer of the prostate at all.

If the biopsy shows cancer, the cancer may not grow quickly enough to cause problems for a man. Still, these cancers are sometimes treated with radiation or surgery when they may not need to be. This is called overtreatment. Surgery and radiation can cause side effects like infections, impotence (inability to get an erection), or problems with the bladder or the bowels.

Still, sometimes screening does show doctors a fast-growing cancer that might pose a danger to a man’s life. Not all medical groups agree about whether men should be screened with a PSA test.

Men should talk their doctor about their risk factors and whether screening for prostate cancer is right for them.