Is frequent PSA testing associated with increased recurrence detection and survival in patients treated for prostate cancer?

The present study evaluated whether more frequent prostate-specific antigen (PSA) monitoring in patients treated for prostate cancer (PCa) was associated with earlier detection of cancer recurrence (return of the cancer) or survival. The number of PSA screenings had no effect on patient survival after treatment for PCa.

One sign for the presence of PCa is elevated PSA blood levels. This is a protein secreted by the prostate gland whose levels rise in prostate disease. There are several therapies available after diagnosis with PCa. These include surgery such as a radical prostatectomy or RP (complete removal of the cancer along with the prostate gland and some tissue around it), radiotherapy (RT), hormonal therapy (also called androgen deprivation therapy or ADT) or active surveillance (periodic monitoring of the disease without applying aggressive treatments). After successful treatment for PCa, PSA levels drop to an undetectable level. However, patients’ PSA levels need to be monitored to determine if the cancer has recurred.

The study included 832 men with PCa who had been treated with RP (55.3%), RT (29.2%), ADT (6%), or active surveillance (9.5%). The frequency of PSA testing was monitored for 2 years after treatment. After approximately 7 years of follow up, 16% of patients experienced a PCa recurrence. Patients with more advanced disease (Gleason scores >7) were associated with more frequent PSA testing. However, the authors of the study found that the frequency of PSA testing after treatment for PCa did not increase survival rates or the ability to detect cancer recurrence. 

In summary, more frequent PSA testing did not affect the detection of cancer recurrence or patients’ survival.

The main drawback for this study is that it looks back at patients who have been treated in the past (retrospective study) rather than following the patients throughout their treatment and determining their outcomes (prospective study). Retrospective studies are considered to provide weaker statistical evidence. Also, given that frequent testing for PSA might increase anxiety in patients, more evidence is needed on the ideal testing frequency.

If frequent PSA testing causes you anxiety, talk to your doctor about reducing its frequency.