Effectiveness of Mass PSA Testing in Reducing Mortality Rates Prostate cancer screening is considered as one of the crucial steps towards dealing with the problem of prostate cancer among various patient population. Healthcare providers consider screening as a crucial issue towards improving the health and well-being of patients. In light of the significance of prostate cancer screening in health promotion, several screening tools have been developed and are utilized in the clinical setting such as digital rectal exam (DRE) and prostate-specific antigen (PSA) testing. PSA testing has received considerable attention in the recent past, particularly in relation to its impact on mortality rates. PSA testing/screening for prostate cancer remains a controversial issue in the modern healthcare setting given the variance in evidence on its impact on mortality rates. This paper examines whether PSA testing reduces morality rates based on research evidence or evidence-based practice. The analysis is carried out based on evidence-based nursing practice, which helps in solving problems through four major steps. These steps are identification of the controversial problem, search for relevant research studies, evaluation of research evidence, and most suitable intervention.

Controversial Issue/Problem

The controversial issue that will be the subject of this paper is PSA testing and mortality rates in today’s clinical setting. According to Vis (2002), PSA-based testing or screening for prostate cancer is one of the major controversial issues in the modern healthcare sector. PSA testing was established following the increased availability of valid screening tests and the likelihood of success of curative treatment alternatives for prostate cancer. Healthcare providers and authorities in the United States have continued to advocate for the use of PSA testing for prostate cancer given these factors.

Prostate cancer is one of the most common and frequent causes of cancer-related death among men aged 65 years or older. It is reported that prostate cancer is the third leading cause of cancer-related death among American men following lung cancer and colorectal cancer. Lung cancer accounts for 44.7% of cancer-related deaths while colorectal cancer accounts for 21.2% and prostate cancer accounts for 20% (Cancer Statistics Center, 2017). The lifetime risk for American men to develop prostate cancer is 16% whereas the risk of dying from this condition is only 2.9% (American Cancer Society, 2017). In this regard, even though prostate cancer is a major health problem, most men diagnosed with the condition do not die from it. However, mortality rates associated with prostate cancer has received significant attention in the health sector in the recent past. Healthcare authorities and professionals consider prostate cancer screening as a crucial element towards lessening the incidence rate, prevalence rate, and mortality rates. Consequently, various tools have been developed to help in screening for prostate cancer including prostate-specific antigen (PSA) testing. While PSA testing is regarded as an important tool for prostate cancer screening, it has remained a controversial issue, particularly in relation to its impact on mortality rates and will be the subject of this paper.

Literature Review

Given the controversy relating to PSA testing and mortality rates, the issue has been the subject of numerous studies that seek to enhance understanding and improvement in clinical practice. Vis (2000) conducted a study to examine whether PSA testing reduce prostate cancer mortality in light of its increased use to screen for prostate cancer. Additionally, the researcher conducted the study on the premise that PSA testing remains a controversial issue in prostate cancer diagnosis and treatment. The study found that PSA testing does not reduce mortality rates contrary to widespread beliefs and assertions. The researcher found that decline in prostate mortality rates even in countries that utilize PSA testing is not attributable to these tests, but brought by the increased use of curative treatment options. For instance, Canada and European countries that discourage the application of PSA testing have experienced reduction in mortality rates because of the increased use of...

These alternatives include diet and lifestyle changes, enhancement in environmental conditions, and early application of luteinizing hormone-release hormone (LHRH) agonists. The declined mortality rates started to occur even before the advent of PSA testing.
Howrey et al. (2013) investigated the effect of PSA testing on prostate cancer mortality rates in the United States. The study examined the issue through a comparison of PSA testing rates in counties in the U.S. to prostate biopsies rates and newly-treated prostate cancer and deaths associated with this health condition. Based on the findings of the research, PSA testing is linked to moderate decrease in prostate cancer mortality. The researchers also found that PSA testing contributes to significant increases in the number of men over-diagnosed and over-treated for this condition.

According to a study by Mitka (2012), mass PSA testing does not result in decrease in the risk of dying from prostate cancer. The research was conducted on an annual population-wide screening for prostate cancer through the use of serum PSA screening and found that the testing does not lessen the risk of prostate cancer death. Similarly, Mulhem, Fulbright & Duncan (2015) contend that PSA testing does not lessen mortality rates. Through a study that evaluates PSA testing, Mulhem, Fulbright & Duncan (2015) found that PSA testing has low specificity and sensitivity for prostate cancer and there is lack of evidence for determining the required threshold that necessitates prostate biopsy. Even though prostate cancer screening increases diagnosis of prostate cancer, PSA testing is associated with some adverse effects including prostate biopsy, overdiagnosis, and overtreatment.

Wilt et al (2014) state that there is minimal or no benefit of PSA testing among older men or those with limited life expectancy. Even though several prospective trials, simulation models, observational studies, and retrospective analyses have been carried out, PSA testing has been found to be of limited or no benefit, especially with regards to mortality rates. The researchers state that there is an agreement between the relevant stakeholders that actual harms are linked to downstream clinical actions and have minimal to no benefit on prostate cancer in terms of mortality rates. In an earlier study, Slatkoff et al. (2011) found that PSA testing is beneficial in some situations and not helpful in others. Based on their study, Slatkoff et al (2011) contend that PSA testing is slightly beneficial to men below the age of 75 years and without cancer or cardiovascular risk factors. However, the slight benefit is inadequate to conclude that PSA testing is helpful in prostate cancer diagnosis and treatment processes. The researchers also argue that PSA testing has significant limitations and possible harmful effects, which largely outweigh its benefits. In this case, PSA testing does not reduce mortality rates because 75% of positive tests are false positives and are linked to psychological damages in some men that could last up to a year after the screening. Some factors that contribute to false positive PSA test results include elevated PSA readings, pre-existing conditions like urinary tract infections, and ejaculation 24 hours before the test. The psychological damages of false positive PSA test results include increased anxiety and stress.

On the other hand, some studies indicate that PSA testing is beneficial and can help lessen prostate cancer deaths. Nelson (2014) who reviewed the impact of PSA testing on mortality rates argued that routine PSA testing for prostate cancer helps in saving lives. Based on updated results from the European Randomized study of Screening for Prostate Cancer (ERSPC), PSA testing has been found to have significant lessening in prostate cancer mortality rates. However, the study does not recommend PSA testing on the premise that its associated with overdiagnosis and overtreatment. In concurrence, Begley (2017) argues that an evaluation of two influential studies on prostrate cancer screening shows that PSA testing lessens death from this condition. One of the influential studies was carried out by the National Cancer Institute i.e. Prostate, Lung, Colorectal, and Ovarian (PLCO)…