Arnsrud Godtman is calling for PSA screening in Sweden to be revamped and an organized program put in place where men are regularly screened.

She would like to see screening start at around age 50 and take place with frequent checks. In order to minimize the risks of overdiagnosis, older men and men with other diseases should not undergo PSA screening according to Arnsrud Godtman’s recommendation.

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The idea is that the risk of overtreatment can be reduced through active surveillance (watchful waiting), where diagnosed men are under careful observation but only treated if the tumor shows signs of becoming more aggressive. Arnsrud Godtman theorizes that 60% of the tumors found in organized PSA screening could be handled with active monitoring.

Gopal Gupta, MD, who is an assistant professor at Loyola University in Chicago, IL, said relying only on opportunistic screening is a serious mistake and disservice. He said the call for changing policy in Sweden is appropriate and could save many lives.

“PSA screening should be deliberate and based on the three big screening trials that showed it saves lives. The idea of overtreatment of clinically insignificant prostate cancers is completely separate from PSA screening. This is more of a question of whether a prostate cancer that is found by screening is clinically significant and requires treatment or clinically insignificant (active surveillance),” said Dr. Gupta.

He said the American Urological Association (AUA) guidelines on prostate cancer screening are getting better and recommend shared decision-making between the patient and doctor advocating screening. Dr. Gupta said men should get a baseline PSA screening at age 40 and then biannual screening.

“To not screen men based on advanced age alone is also a mistake, as we really need to identify which cancers can metastasize and cause death, not based this judgment on age alone,” Dr. Gupta said in an interview with Cancer Therapy Advisor. “The role of multiparametric MRI is really rapidly advancing how we think about prostate cancer. PSA is used to screen for prostate cancer, but we have made no progress on increasing our detection by transrectal ultrasound biopsy alone.”

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He said if a man has an elevated screening PSA level, he should undergo multiparametric MRI to better assess areas of suspicion for prostate cancer in his gland and then a targeted biopsy. He said with this approach more men would be better served on active surveillance.

Gerald Andriole, MD, who is the head of Urologic Surgery at Washington University School of Medicine in St. Louis, MO, said in the United States the pendulum has swung a little too far against screening PSA.

“The data show we have used PSA incorrectly and too aggressively. Unfortunately, the recent guidelines and recommendations have gone too far. We have to find the middle ground and the proper use. It was too intensive initially and not intensive enough now,” Dr. Andriole told Cancer Therapy Advisor.


  1. Arnsrud Godtman R. Goteborgs Universitet. Prostate Cancer Screening – Aspects of Overdiagnosis. Published November 28, 2014. Available at February 25, 2015.