THOUGHTS ON PSA SCREENING: Integrative Functional Medicine Physician Perspective in San Antonio TX and Quincy IL.
- John Kim
- Sep 17
- 3 min read
PSA Screening: Balancing Lives Saved and Lives Harmed – What You Need to Know
Prostate cancer is a significant health concern, and prostate-specific antigen (PSA) screening is often presented as a tool to catch it early. But like many medical interventions, PSA screening comes with both benefits and risks. As an integrative functional medicine physician, I believe in empowering you with the knowledge to make informed decisions about your health. Let’s break down the evidence behind PSA screening, so you can weigh the potential benefits against the possible harms.
The Benefits of PSA Screening: Lives Saved
PSA screening can reduce the risk of dying from prostate cancer, particularly in men aged 55–69. However, the impact is modest, and it requires screening a large number of men to save a single life.
Reduction in Prostate Cancer Deaths: For every 1,000 men screened over 10–13 years, about 1–1.3 lives may be saved from prostate cancer. This benefit is more pronounced in men at higher risk, such as those with a family history or Black men, who may see greater reductions in mortality.
Fewer Cases of Advanced Cancer: Screening can prevent about 3 cases of metastatic (advanced) prostate cancer per 1,000 men screened over 12 years.
Numbers to Consider: To prevent one prostate cancer death, 781 men need to be invited to screening, and 27 men need to be diagnosed and treated. These numbers highlight the scale of screening required to achieve a small reduction in mortality.
While these benefits are real, it’s important to note that PSA screening does not reduce overall mortality (the risk of dying from any cause). This means that while fewer men may die from prostate cancer, their overall lifespan may not change.
The Harms of PSA Screening: Lives Impacted
The risks of PSA screening often stem from overdiagnosis—detecting cancers that would never have caused harm—and the subsequent treatments, which can lead to significant side effects.
Overdiagnosis: For every 1,000 men screened, 18–50 will be diagnosed with prostate cancer that may never have caused symptoms or affected their lifespan. These men often undergo unnecessary treatments.
False Positives and Biopsy Risks: PSA tests can produce false positives, leading to anxiety and unnecessary biopsies. About 150–178 men per 1,000 screened will experience at least one false-positive result, and many will undergo biopsies, which carry risks like infection, bleeding, and urinary issues.
Treatment Side Effects: Treatments such as surgery or radiation can cause:
Urinary Incontinence: 3 more men per 1,000 screened may experience incontinence.
Erectile Dysfunction: 25 more men per 1,000 screened may face erectile dysfunction.
Psychological Impact: The stress of a cancer diagnosis and treatment can take a toll on mental health.
A Holistic Approach to Decision-Making
As an integrative functional medicine physician, I advocate for a personalized approach to PSA screening. Here are some key considerations:
Understand Your Risk: Factors like age, family history, and ethnicity play a role in your risk of prostate cancer. For example, Black men and those with a family history may benefit more from screening.
Weigh the Benefits and Risks: For every life saved, many more men may face unnecessary treatments and side effects. Ask yourself: Do the potential benefits outweigh the risks for me?
Shared Decision-Making: Discuss your options with your healthcare provider. Together, you can consider your values, preferences, and overall health to make the best choice for you.
Focus on Prevention: Beyond screening, lifestyle factors like a healthy diet, regular exercise, and stress management can play a significant role in reducing your risk of prostate cancer.
The Bottom Line
PSA screening is not a one-size-fits-all solution. For every 1,000 men screened, 1–1.3 lives may be saved from prostate cancer, but many more will face overdiagnosis, unnecessary treatments, and side effects like incontinence or erectile dysfunction. The decision to screen should be made thoughtfully, with a clear understanding of the potential benefits and harms.
If you’re considering PSA screening, I encourage you to have an open conversation with your healthcare provider. Together, we can create a plan that aligns with your health goals and values, ensuring that your care is as personalized and integrative as possible.
By taking a holistic view of your health and staying informed, you can make empowered decisions that support your well-being. If you have questions or want to explore your options further, feel free to reach out—I’m here to help.
Yoon Hang Kim MD MPH
Comments