The Ethical Dilemma Surrounding Prostate Specific Antigen (PSA) Screening

The Food and Drug Administration approved testing for prostate cancer screening in 1994. Today over four decades have passed since the Prostate-Specific Antigen (PSA) was first discovered. Yet enormous uncertainty governs the effectiveness of PSA testing as well as the appropriate strategy to best detect early prostate cancer. Many groups including the American Cancer Society (ACS), the National Comprehensive Cancer Network (NCCN), the American Urological Association (AUA) and the US Preventative Services Task Force (USPSTF), have issued a series of clinical guidelines for prostate cancer screening with inconsistent recommendations. Research shows that prostate cancer screening with PSA resulting in a false-positive screen occurs among 80 percent of men, while 20 percent of men have false-negative results. Recently changes to existing recommendations were suggested by the USPSTF due to concerns of negative effects of PSA testing on patient outcomes. While the evidence underlying prostate cancer screening recommendations is continuously in flux, it is important to understand implications of the debate for clinicians and men. In this paper we examine ensuing ethical considerations of PSA screening for prostate cancer.