We commend Ben Stiller for sharing his experience of being diagnosed with prostate cancer. Thanks to a wise and informed clinician, he has been saved from joining the ever increasing ranks of men diagnosed with advanced and incurable prostate cancer, which is partly as a result of the continuing misinformation and negative publicity about the PSA Test. This is exemplified by the ill-informed recommendation from the US Preventative Services Task Force (USPTF) that the test should not be offered to asymptomatic men. Well-informed clinicians (such as Mr Stiller’s) wisely ignore this recommendation, but it still has great influence over those clinicians not expert in the field, or do not have the time to read up and understand this complex problem.
No man was ever harmed by knowing his PSA. The harm, if it comes, used to come from what clinicians do with the results. But the rush to invasive diagnosis and over-treatment common in the last century is rarer these days as an intelligent, informative and risk-based approach is adopted in most centres. Examples of this are increasing use of MRI before biopsy, and the adoption of Active Surveillance as a management regime for low risk disease. What is important to point out is that all these techniques depend on an initial PSA test.
If PSA testing of asymptomatic men were to be stopped (as the USPTF would wish) the vast majority of men who develop prostate cancer would present with later stages of the disease that has spread beyond the prostate, and in most cases they would die from it.