The Great PSA Controversy

Confusion

I’ve heard PSA screening referred to as one of the top controversies in men’s health. And where there’s controversy there’s confusion. Given that prostate cancer is the number two cause of cancer deaths among men, confusion around screening for the disease is problematic and potentially dangerous. A Philadelphia-based genitourinary surgeon named Alexander Kutikov recently attempted to clear things up in an article entitled, How a teenager’s question helped this prostate cancer expert reframe the great screening debate.” It’s a good piece, which I have since tweeted and posted on Facebook.

As hard as Kutikov works to “reframe” the controversy, he doesn’t give quick-and-easy guidelines. Instead, he reminds us that, because prostate cancer is so common, it presents a myriad different “shades” of the disease, with each unique patient scenario requiring education and discussion with one’s doctor. He suggests that the best public health message is “Screening is complicated. Get educated, then talk to your doctor.” If you’re looking for the CliffsNotes version of PSA screening, you won’t love his article. But he’s still right.

I’m no doctor, but I favor the idea of getting a PSA every year if you’re a man over 50. Sure, you may get what Kutikov refers to as a “false positive result.” But if you take the time to get educated about PSA before your screening—and have meaningful well-informed discussions with your doctor at every step—there’s no reason why a false positive should send you into a tailspin of worry or over-treatment. That being said, I appreciate that Kutikov doesn’t serve up PSA screening as simple just because we want it that way. We can handle the truth.

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