PSA screening started in 1994. Since then the overall rate of death from prostate cancer has declined. However, some studies have argued that the death rate reduction cannot be directly attributed to screening, while screening can also lead to treatments that may cause temporary or longer term sexual dysfunction and/or incontinence. Many prostate cancers are indolent and grow so slowly that men die from something other than the cancer, so the treatment may be unnecessary.
The United States Preventive Services Task Force (USPSTF) recommended against PSA screening in healthy men, finding that the potential risks outweigh the potential benefits. However many urologists, as well as many patients who have been successfully treated, believe that PSA screening, along with digital exams and biopsies, saves lives.
According to the American Urological Association, the controversy over prostate cancer screening should not inhibit testing, but rather can show how test results influence the decision to treat. Testing empowers patients and their urologists with the information needed to make an informed decision. The Association does not recommend screening for men age 40 or under, for men age 41 – 54 with average risk, or for men age 70 or older. They recommend that men between 55 and 69 should discuss screening with their doctor.