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Subspecialties Precision medicine, Profession, Screening and monitoring, Regulation and standards, Oncology

PSA: A Shared Decision

“As a urologic oncologist and health services researcher, I am interested in the downstream effects of changes in health policy […] on population-level outcomes for men at risk for prostate cancer and other urologic cancers.” Christopher Filson, Assistant Professor of Urology at Emory University School of Medicine, acknowledges the difficulty of selecting populations for prostate cancer screening using prostate-specific antigen (PSA), and of limiting screening to those who will reap the greatest benefit. The outcome? A reduction in overall testing – as observed in a recent study (1) – and, hopefully, more appropriate management for both those who are screened and those who are not.

But is a decrease in prostate cancer screening a bad thing? Filson doesn’t think so. “The controversies surrounding prostate cancer screening with PSA testing stem from the inherent complexity of the subject matter, as well as strong vested interests and prior biases from people involved in the conversation,” he says. It’s hard to deny the strong association between a large population-level decrease in prostate cancer mortality in the United States after broad adoption of PSA screening – although, Filson adds, some do not admit to a causal linkage between the two. Continued efforts to identify those who would benefit most from PSA screening (such as those with strong family history) will reduce unnecessary testing and treatment in those with less to gain (such as men over 75 years of age).

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