After all this back and forth about what the "study" said I read the linked article (It isn't a study, it is a recommendation based on a lot of studies). What it says (or at least what I think it says) can be distilled to this. Most men who get a positive PSA test will go on to get a biopsy. But about 80% of those results are false positives so those guys get the negatives of a biopsy for naught. Of those whose biopsies show a cancer almost all of them will have treatment even though though most of the cancers would progress slowly and never have resulted in clinical symptoms before death from other causes. The aggressive or otherwise dangerous cancers will be detected later by clinical symptoms and would then be treated anyway. So the net result of screen is a lot of angst and earlier treatment of some cancers. It is those few guys who will get the earlier treatment of dangerous tumors that we are concerned with and why some of us have supported getting the screen.
BUT, the statistics show that the benefits are minimal or none. The studies found NO advantages from screening for men over 70. And the studies showed marginal if any benefits for men 59-70. From the recommendation:
"The evidence is convincing that for men aged 70 years and older, screening has no mortality benefit. For men aged 50 to 69 years, the evidence is convincing that the reduction in prostate cancer mortality 10 years after screening is small to none." If all of this is accurate then most (maybe not all) of the guys who got early treatment due to the test/biopsy would have gotten treatment later due to clinical syptoms and would end up with a similar result. The recommendation is to rely on clinical symptoms, not PSA screening to counsel a biopsy and subsequent treatment if a cancer is found. They are saying YOU are better off waiting for symptoms before getting a biopsy. This is not a cost tradeoff it is a straight benefit to you recommendation. Here is another quote:
"The common perception that PSA-based early detection of prostate cancer prolongs lives is not supported by the scientific evidence. The findings of the two largest trials highlight the uncertainty that remains about the precise effect that screening may have, and demonstrate that if any benefit does exist, it is very small after 10 years. The European trial found a statistically insignificant 0.06% absolute reduction in prostate cancer deaths for men aged 50 to 74 years, while the U.S. trial found a statistically insignificant 0.03% absolute increase in prostate cancer deaths (
6,
7). A meta-analysis of all published trials found no statistically significant reduction in prostate cancer deaths (
10). At the same time, overdiagnosis and overtreatment of prostatic tumors that will not progress to cause illness or death are frequent consequences of PSA-based screening. Although about 90% of men are currently treated for PSA-detected prostate cancer in the United States—usually with surgery or radiotherapy—the vast majority of men who are treated do not have prostate cancer death prevented or lives extended from that treatment, but are subjected to significant harms."
From a money perspective it seems like the test simply pumps money into the medical system with no evidence that the money makes a difference. Since the advent of testing a million men have had surgeries/radiation who would not have had them otherwise: "
From 1986 through 2005, PSA-based screening likely resulted in approximately 1 million additional U.S. men being treated with surgery, radiation therapy, or both compared with before the test was introduced."
I plan to talk to my primary care physician about this at my next physical. My inclination would be to skip the PSA screen and rely on clinical symptoms. But I would be open to a rational discussion about why I might be wrong.