Over the last several years, the medical community has voluntarily decreased the use of screening PSA in some patient populations. As a whole, we are being more selective in regards to the patient's that we perform screening on. Patient's with risk factors such as African-American race, family history or significant change in urologic symptoms absolutely require screening PSA as part of their evaluation.
Much of the criticism surrounding PSA comes from overtreatment of low-grade prostate cancer when diagnosed by PSA screening. In my practice, virtually all of the patient's with low volume low-grade disease are not seeking active treatment and rather are on active surveillance. I reserve more aggressive treatment with surgery or radiation for those patients demonstrating aggressive disease which does pose a threat to their life and well-being. It is absolutely essential that this test remain an option for well informed judicious physicians that use the test appropriately to diagnose prostate cancer in a timely manner when treatment is most efficacious.
If PSA screening becomes a thing of the past, we will return to the past with aggressive metastatic disease incurable and often untreatable being diagnosed on a regular basis. Medical Knowledge research and practice has advanced so far, let us not ignoranty and voluntarily return to the past.