Prostate-Specific Antigen Testing Not Effected by Guidelines

The change of prostate cancer screening guidelines discouraging the use of prostate-specific antigen tests did not decrease the utilization of the test, a recent study published by Cancer found.

Prostate-specific antigen tests check for levels of the protein, which is produced in the prostate gland. High levels can be associated with prostate cancer, but can also be associated with an absence of cancer. Low levels of prostate-specific antigen can also indicate the presence or lack of prostate cancer.

Due to conflicting results, the United States Preventive Services Task Force set new guidelines that state the harm of overtreatment from these tests were more significant than potential benefits of early detection. Overtreatment can result in erectile dysfunction and incontinence.

Other associations, such as the American Cancer Society and the American Urological Association, suggest that patients and physicians discuss testing options instead of ruling out the test. Scientists examined data from more than 275,000 electronic medical records of patients who visited UT Southwestern Medical Centers from 2010 to 2015.

During this time, 63,000 prostate-specific antigen (PSA) tests were ordered.

“We used actual, real-world data and found that changes in PSA use, if any, are likely small,” said researcher Yair Lotan, MD. “Many recent studies have claimed that the task force recommendations against PSA screening have caused a major change in prostate cancer screening. These studies were based on data sources including surveys, which could be subject to significant bias.”

They discovered that these new guidelines did not dissuade physicians from ordering the tests, since their findings indicated a similar number of tests ordered before and after the guidelines, according to the study. However, scientists did find that prostate-specific antigen levels were higher in the tests occurring after the guideline, which may suggest that physicians may have waited to conduct tests.

The scientists said that slightly higher prostate-specific antigen levels would likely have little to no effect on treatment.

“Despite a 39% decrease in prostate cancer mortality since 1991, when PSA screening became widespread, controversy about the benefits and harms of PSA-based screening remains,” Dr Lotan said. “Potential harms of PSA testing include false positives, which create anxiety, and overdiagnosis, which can potentially impact the patient’s quality of life.”