The PSA Screening Picture: Paint by Numbers

May 19, 2016

By Greg Vachon, MD, MPH

Okay, so let’s say there is an opportunity for PSA to be added to your company’s annual wellness screening and the vendor says, “There is no added cost!” Should you do it? NO! It will end up costing a bunch and will harm your employees. How so? Let us paint the picture in numbers.

First, PSA (Prostate Specific Antigen) is a test used to screen for prostate cancer. The idea is that early detection will lead to treatment and cures. Unfortunately, the idea doesn’t work.
So what do the numbers say? Let’s take a theoretical set of 2,000 men, half screened every year for ten years and look at screened versus unscreened in the things that matter. Death? That’s important, for sure, but guess what? No difference. How about death from prostate cancer? 4 in the screened group, but only 3 in the leave-‘em-alone group! Makes sense, because treatment can kill you. One in every few hundred men that get the biggest type of prostate surgery will die within 30 days. Ouch. 

And what about quality of life? Three more guys will suffer with erectile dysfunction in the screened group and two more will have urinary incontinence that they wouldn’t have had if they’d just been left alone!

How much will it cost to get these extra men with incontinence and erectile dysfunction? The extra biopsies, cancer treatments, missed work, medications and, yes, diapers will cost well over a million dollars, a good part of it charged right to you, their employer. Without one death saved. Do everyone a favor and don’t over screen. 

This doesn’t mean aggressive treatment doesn’t make sense if a person has symptoms and is found to have prostate cancer. Or if PSA levels are checked by a doctor because there is high risk for some reason. But it does mean that screening widely, particularly across an employed population, is costly and harmful. Don’t get harmed. Decline the “free” PSA. Similar dynamics are at work for other tests like hemoglobin and calcium and Vitamin D and thyroid tests. Don’t get screened! Just see your doctor if you don’t feel well.  

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