The PSA Testing Controversy

29000 Men Comment

The medical and medical journalistic community continue to struggle with the issue of PSA testing for prostate cancer. The issue is the treatment of prostate cancer that is slow-growing and not a major threat. The difficulty is that is extremely difficult to determine which prostate cancers are “benign” and which are aggressive and life threatening. It seems a bit ironic that we have this major focus on over testing for prostate cancer but no similar debate about testing for breast cancer, when the two cancers are virtual mirror images in terms of annual new cases and death rates.

The issue, I believe, is not in over testing for prostate cancer, since early detection is essential for effective treatment of aggressive prostate cancer, but with the level of knowledge men have about prostate cancer and the various forms of treatment. Current American Cancer Society statistics show that only 54% of men test annually for prostate cancer and that almost 29,000 men die each year from the disease. My conclusion is that we are undertesting the male population as a whole, and possibly over treating those are identified. I would love to have a dialogue on this issue.

Dr. Mark Scholz, head of the Prostate Cancer Research Institute in Los Angeles, published the following statement that, I believe, succinctly summarizes the dilemma. My suggestion would be to follow Dr. Scholz’s advice; test, but take the time and steps necessary to ensure you have a form of prostate cancer that requires treatment.

Best regards, Robert

Re: Letter to the Editor Regarding a Wall Street Journal Article titled: 
Two Big Studies Tackle Debate on Prostate Test published on Thursday March 19, 2009


The Wall Street Journal recently published a letter to the editor under the heading, “Lifestyle Is Fine, but Cancer Needs Effective Treatment.” The physician writing the letter vilified the idea of using anything but surgery to treat his prostate cancer. Unfortunately, his uninformed convictions are prevalent throughout the medical community. Now definitive, well-performed studies unequivocally prove that overtreatment is the norm (New England Journal of Medicine 2009;360:1310-9 and 1320-8) .


As has been the case for years, the a priori assumption that “all cancer needs treatment” has confused the expert commentators who are interpreting these crystal-clear study results as being part of an ongoing unresolved controversy about PSA testing. The reality is that huge amounts of precious research dollars are being spent to answer a foolish question. Whether or not to do PSA testing is not the issue. The issue is deciding what to do with the information the PSA provides.


Right now the nation is in the grip of 8-billion dollar industry hell-bent on administering treatment to every kind of prostate cancer whether it is life-threatening or not. The solution to the problem of over-treating prostate cancer is not less PSA testing. The solution is educating physicians to forgo recommending immediate surgery or radiation to every last man who gets a diagnosis of prostate cancer.

Newly-diagnosed patients need to research all their options before agreeing to irreversible radical treatment. PSA testing (in conjunction with other means) has a useful role in determining which men harbor the more aggressive types of prostate cancer. Only with a “go slow” approach, ongoing monitoring known as Active Surveillance, can we distinguish men with aggressive disease who need treatment from men with indolent disease who don’t need treatment.


Mark Scholz, M.D. 
Prostate Cancer Research Institute
Los Angeles, California