Dr. Robert Reiter, professor of urology and director of the Prostate Cancer Program for the UCLA Health System, argued that the harms of diagnosing some patients who may not need treatment is far outweighed by the benefit of catching some deadly cancers early.
"The reality is that the goal of early diagnosis will become increasingly relevant for all cancers, in as much as the only way to reduce death from cancer is to diagnose them even earlier," Reiter said. "There is not nearly as much overdiagnosis as these individuals think."
The National Cancer Institute says that if a man does have an elevated PSA level, it does not necessarily mean he has cancer. Rather, a highly positive PSA test may be reason to look to other diagnostic tests. These tests may include imaging procedures like ultrasound and X-rays, as well as a test called cystocopy in which a doctor uses a thin, flexible camera to peer into the urethra and bladder. Doctors may also perform a biopsy to determine if cancer is, indeed, present.
Still, the ACS does not support routine testing for prostate cancer. Other professional organizations vary in their recommendations on who should receive a PSA screening, and how often. The reason for the disparity in screening recommendations for prostate cancer often centers on the fact that the PSA test can only tell you if the cancer exists, not how serious or fast-growing the disease is.
And while the PSA test may save lives, past research has shown that the benefits of regular PSA screenings are highly questionable.
A study published in the Journal of General Internal Medicine in 2008 finds that regions in the United States that screen and treat early-stage prostate cancer more intensively generally don't show a lower death rate from the disease.
Dr. Donald Berry, chairman of the department of biostatistics and chairman of cancer research at the M.D. Anderson Cancer Center, said that he is strongly against PSA screening.
"I'd pay lots of money to not know my PSA level," Berry said. "Not all prostate cancers are the same, and some are not cancers at all, at least not in the way we usually think about cancer. ... The problem with PSA screening is that it disproportionately finds the noncancers."
The real problem, Berry said, is that because prostate cancer treatment is associated with such a high rate of impotence and incontinence, "the cure can be worse than the disease .. .[and] much of what is being cured never was a disease in the first place."
Dr. Mark Soloway, professor and chairman of the Department of Urology at the Miller School of Medicine in Miami, agreed that some patients who fall into the gray area when it comes to their need for treatment are the ones who are most vulnerable to overtreatment.
"The problem occurs when a patient is confronted with a diagnosis of [prostate cancer] and the doctor indicates that it requires treatment," Soloway said, adding that financial motivations may drive some doctors and hospitals to treat patients, even when these patients are too low-risk or old to justify such care.
"A robot to perform a ... robotic prostatectomy costs $1.5 million, and there is an incentive to use it," he said. "The hospital buys it to be used, and the surgeon wants to keep up his skills.
"There are incentives to treatment, and the public should be aware of them."