Prostate screening does more harm than good in US

Doctors should stop screening for prostate cancer because it does more harm than good. This advice comes more than a decade after the prostate-specific antigen (PSA) test was introduced in the US.

"PSA-based screening for prostate cancer has no net benefit," concludes the US Preventive Services Task Force, which evaluates screening services. The dangers of PSA-based screening include a high rate of false positives, negative psychological effects, and complications associated with diagnostic biopsy and treatment, the task force says.

Between 1986 and 2005, 1 million men in the US had surgery and radiotherapy for prostate cancer after a PSA test, but the panel found no evidence this prevented more deaths than "watching and waiting". However, between 200 and 300 men in every thousand treated developed incontinence or erectile dysfunction.

"It's encouraging to see a real debate on the impact of the PSA test on patient outcome," says John Semmes of Eastern Virginia Medical School in Norfolk.

"I think their decision is premature because there's more data coming in on whether screening is beneficial or not," says Freddie Hamdy of the University of Oxford, chief investigator of the UK ProtecT study, which is investigating the issue.

William Catalona, director of the clinical prostate cancer programme at Northwestern University in Chicago, agrees: "PSA is the best screening test we have for prostate cancer, and until there is a replacement, it would be unconscionable to stop it," he says.