What you need to know about studies like this one on the value of PSA testing is that they draw their statistical conclusions from populations rather than individuals. This allows the researchers to conclude that routine PSA screening for cancer in "younger" individuals doesn't show much "benefit" (again in terms of population outcomes) compared to the "cost" and/or "risk" of such screening. The study seemed to be well-designed and analyzed. What does that mean for you as a guy who wants to catch a prostate Ca early when it could be cured? Actually, it means very little, because the study deals with "population" risks/benefits.

The PSA is a simple blood test. It costs money (about $100 for the test plus some more for the doctor visit). A negative test doesn't absolutely exclude prostate Ca, but for all practical purposes it does exclude it. A high PSA (>5) level is suggestive of Ca, but could be due to relatively benign things like prostatic hypertrophy or a low level prostate infection. A really high level (say >20) is highly suggestive of Ca.

A high PSA may lead to invasive and potentially harmful procedures, like biopsy, and it's clear that subjecting everyone over 50 to PSA testing will lead to many arguably unecessary biopsies. It will also lead to lots of expensive testing and even risky diagnostic procedures, at least as far as the healthcare expense beancounters are concerned. But it is also true that such testing will, in a certain number of cases, allow for the detection of early stage asymptomatic and curable prostate Ca...For those "individuals" the routine PSA testing will be life-saving.

There's another angle to all this. Prostate Ca is fairly common in older men...the incidence increases with age, and the majority of men >75 years old will have cancerous cells in their prostates. Few will die from prostate Ca. I recall our US Senator from California, Alan Cranston, who basically escaped prosecution for his being involved in the Keating Five scandal because of his prostate Ca diagnosis...he lived for many years and died of something else. There was also that Libyan Lockerbie bomber terrorist who was recently paroled from a British prison because of his prostate Ca diagnosis...So far as I know the bastard is still alive and will, like Senator Cranston, die of "old age." This doesn't mean that prostate Ca is nothing to worry about. Prostate Ca is serious business. It is particularly serious when diagnosed in younger men, where it typically presents more aggressively than in older guys. And it is this younger population that will suffer from the conclusions of this study.

For the purposes of full disclosure, I am a physician. I was aware of this study's recommendations about routine PSA testing in "younger" men, but I chose to get tested when I turned 50. The result was negative. I plan to get tested every 5 years, rtegardless of symptoms, and if my PSA becomes elevated I'll procede accordingly.