PSA testing is a fine line that physician and patient must walk together, he said. "Every single organization in the world has said mass screening is inappropriate and that it should be done in the context of a single man and his understanding of his own risk factors and the risks and benefits of screening. The problem with this recommendation is that it takes all the nuance and complexity of this interaction and simply says, ‘Don’t have the discussion.’ The American public makes risk-based decisions all the time, after looking at the pros and cons of an issue – and I think people can weigh this out themselves without having someone else to say ‘Follow my priorities instead of your own.’ "
Dr. Brian McNeil, chief of urology at the University Hospital Brooklyn, N.Y., said that individual risk assessment is the key to using PSA wisely. During the meeting, Dr. McNeil presented a case series of 148 black men in their 60s, all of whom came to him with symptoms that turned out to be metastatic prostate cancer.
"A white male with no family history and no other risk factors can probably safely delay a PSA test until age 50," he said in an interview. "But some men you will want to begin screening at age 45 or even age 40."
The prostate cancer patient's quality of life is something that "gets lost in this screening argument," he said. "Nobody ever talks about how it feels to have a bony metastasis or a big cancerous prostate obstructing your bladder. Screening can catch these cancers earlier so we can save our patients from this kind of thing."
Dr. Dilip Doctor, who practices in Flushing, N.Y., said doctors have a "moral and legal obligation" to screen for prostate cancer. If physicians neglect to provide this inexpensive test, he said, they could experience some legal difficulties.
"No patient is going to forgive you for missing his cancer that could have been diagnosed with a PSA," he said in an interview. "You might read this article and think about it. But listen, those guys are not going to come down and defend you in a lawsuit. The only thing to protect you is to practice good medicine and that means doing the only test available and that is a PSA. If you don’t do it, it’s negligent."
None of the physicians interviewed for this article declared having any financial relationships.
* Correction (5/25/12): An earlier posted version of this story incorrectly stated the follow-up period of the original ERSCP study published in 2009. At that time, the follow-up period was 9 years.