The lethal fallout of the PSA smear campaign

I’ve always been one of the loudest voices out there declaring my disgust at how many men have been overtreated for prostate cancer. But I never once abandoned the idea of routine PSA screening. 

After all, it’s not the fault of the PSA test that overzealous doctors used its results to justify barbaric and excessive treatment plans. Especially when you consider how PSA screenings are just one piece of a much bigger puzzle in the effort to identify aggressive prostate cancers. 

But, as it turns out, it may be a more important piece than most people realize 

Throwing the baby out with the bathwater    

New research shows that rates of diagnosis for metastatic prostate cancer have spiked in the U.S. right alongside decreases in PSA testing. 

Scientists recently looked at state-by-state data from the North American Association of Central Cancer Registry, all collected between 2002 and 2016. (PSA testing started to really decline around 2010.)  

They found that between 2008 and 2016, in particular, the mean percentage of metastatic prostate cancer diagnoses jumped from 6.4 to 9 percent per 100,000 men. At the same time, the percentage of men getting PSA testing dropped from 61.8 percent to 50.5 percent.  

Coincidence? Not likely: Statistical analysis also showed that states with greater screening declines suffered higher spikes in prostate cancers that were metastatic at diagnosis. Which shows that, once again, American medicine has thrown the baby out with the bathwater.  

It’s nothing new, of course. It seems that no one in the medical profession thinks for themselves anymore. (Remember the endocrinologist dilemma I told you about just yesterday?) 

But maybe with this news, we can finally start to look more into the nuances of medicine 

Knowledge is power 

Let me be clear: There was never any doubt that PSA screening helped reduce prostate cancer metastasis and mortality. But it has also been clearly linked to over-diagnosis and over-treatment of prostate cancer. In turn, the U.S. Preventive Services Task Force started poo-pooing this screening tool in 2008.  

By 2012, they had advised against the PSA completely. Ultimately, it took several studies showing rises in metastatic prostate cancer diagnoses alongside decreases in PSA screening before they walked that guidance back and updated their recommendation.  

Then, in 2018, they stated that men between the ages of 55 and 69 years should make an individual decision about whether to be screened after a conversation with their clinician about the potential benefits and harms. (While still recommending against PSA screening in men over 70 years.) 

Of course, this would require doctors to actually talk more in-depth with their patientsUnfortunately, most physicians these days have employers that are more interested in cost savings than in doing what is right for the patient. And no one is ever willing to make a decision based on the clinical facts.  

But it should be obvious by now that nothing in this arena is black and white—no matter how much hospitals and insurance companies may want to oversimplify things for the sake of their bottom line. 

That’s why I consistently screen every single one of my male patients. I consider it one more piece of the puzzle for achieving good health. After all, the ultimate goal of medicine is to make smart treatment decisions. And information helps us do that… sticking our heads in the sand doesn’t.  

Again, the only real risk attached to PSA testing is having an overzealous doctor who misinterprets the results. But not having those results in the first place could clearly cost you your life. So… find a doctor you can trust—and continue to get screened regularly. 

Not yet convinced? I reported more details in the January 2017 issue of my monthly newsletter, Logical Health Alternatives (“Why the government’s backpedaling on PSA again—and how you can make the most of this lifesaving prostate test”). Click here to sign up today!


“Drop in PSA Screening Linked to Increase in Metastatic Prostate Cancer.” HealthDay News, 02/16/2021. (