Wiki Prostate

What are the potential harms or risks associated with prostate cancer screening?

Prostate cancer screening, particularly with the prostate-specific antigen (PSA) test, can have potential harms and risks, which need to be carefully considered alongside the potential benefits. Some of the main risks and harms associated with prostate cancer screening include:

1. False-Positive Results: PSA testing can lead to false-positive results, where PSA levels are elevated but no cancer is present. False-positive results may lead to unnecessary anxiety, further testing (such as repeat PSA tests or prostate biopsies), and potential complications from invasive procedures.
2. False-Negative Results: Conversely, PSA testing can produce false-negative results, where PSA levels are normal despite the presence of prostate cancer. False-negative results may delay diagnosis and treatment, allowing the cancer to progress to a more advanced stage before detection.
3. Overdiagnosis: PSA screening may detect slow-growing or low-risk prostate cancers that may never cause symptoms or harm during a man’s lifetime. However, these cancers may still be treated aggressively, leading to unnecessary procedures such as surgery, radiation therapy, or hormone therapy, which can result in side effects such as urinary incontinence, erectile dysfunction, and bowel problems.
4. Overtreatment: Overdiagnosis of prostate cancer can lead to overtreatment, where men undergo unnecessary procedures and treatments for cancers that would not have caused harm. Overtreatment can result in physical and psychological side effects, decreased quality of life, and increased healthcare costs.
5. Biopsy Complications: If an abnormal PSA result leads to a prostate biopsy, there is a risk of complications such as infection, bleeding, urinary difficulties, pain, and discomfort. While serious complications are rare, they can occur and may require medical intervention.
6. Anxiety and Psychological Impact: The uncertainty surrounding prostate cancer screening, the possibility of abnormal results, and the need for further testing can lead to anxiety, stress, and psychological distress in some men.
7. Treatment Side Effects: If prostate cancer is detected and treated based on screening results, the treatments themselves can cause side effects such as urinary incontinence, erectile dysfunction, bowel problems, fatigue, and decreased quality of life.
8. No Mortality Benefit: While PSA screening can detect prostate cancer at an earlier stage, there is ongoing debate about whether it reduces prostate cancer mortality. Some studies have found a modest reduction in prostate cancer deaths with PSA screening, while others have not demonstrated a clear benefit.

Given these potential harms and risks, many medical organizations recommend shared decision-making between patients and healthcare providers regarding prostate cancer screening. This approach involves discussing the risks and benefits of screening, considering individual preferences and values, and making informed decisions based on the best available evidence. Additionally, ongoing research is focused on improving the accuracy of screening tests and identifying biomarkers or imaging techniques that can better distinguish between aggressive and indolent prostate cancers.