Prostate Cancer Screening and PSA: The Facts

  1. The mortality rate from prostate cancer in the US is over 33,000 per year and increasing. It is the second most common cancer death in US men.
  2. In 1991, prior to utilization of PSA screening, 20% of men diagnosed with prostate cancer had bone metastases. Today less than 4% of men diagnosed with prostate cancer have bone metastases.
  3. From 1994 to 2004 the mortality rate from prostate cancer plummeted 40%, a decrease in mortality greater than any other cancer diagnosed in men or women.
  4. The National Cancer Institute estimates that of the observed decrease in mortality from prostate cancer, 40-70% of this decline is due to PSA screening.
  5. In Great Britain where PSA testing is not utilized, 50% of men diagnosed with prostate cancer survive 5 years. In the US where PSA testing is utilized, 90% of men live 10 years.
  6. In almost every country utilizing PSA screening the mortality rate has decreased.
  7. Proper screening involves an annual PSA AND an annual DRE or Digital Rectal Examination. Both are important and both should be performed.
  8. Screening should begin at age 40. The expected PSA value in 40-year olds is 0.7. The expected annual increase in PSA is 0.1 per year. If the PSA increases by more than 0.4 per year, the patient’s PSA has “broken the speed limit” and close follow up is warranted. Patients aged 45 to 50 should have a PSA of 1.5 or less.
  9. PSA screening must be used appropriately. For example, a man aged 75 with a PSA less than 2 will not likely die of prostate cancer. Men with a life expectancy of less than 10 years do not need PSA screening.