There's a big difference between how doctors traditionally think about screening and how patients should think about it.
Let's say I'm a doctor, and I'm considering all my patients as a group. I have 1,000 men that I'm trying to save from prostate cancer. That's about this many guys:
Source: NYS Archives
I know that if I do PSA screening on all of them, I will save one from dying of prostate cancer. So it seems like a good idea to me, and I start the screening, and do this for 11 years. (The following is based on the book Cancer Screening Decisions by R.N. Adler, 2018.)
890 of these men will never have prostate cancer. 780 have negative tests. 100 men have positive PSA testing, and then have biopsies. 32 men have complications of the biopsy. 66 men get prostate cancer, diagnosed either from the screening or symptoms. So OK, I have a bunch of testing in this population, and 32 men have complications from the biopsy, but overall I'm saving one life, so that seems worth it.
Now let's imagine I'm one of the men in the picture. What are the chances I'm going to be the one person saved by the test? Well, literally it's 1 in 1,000. Let's say I worry about it and I want to get the testing anyway. What is the price of the bet that I'll be that 1 in 1,000? PSA testing for 11 years, and a 1 in 10 chance I'll have a biopsy, and if I have a biopsy, a chance that I'll have a major complication like an infection.
I can tell you that many men, after this discussion, will decide not to have the test.
There are decision tools out there now that help providers have conversations with patients about this exact problem: identifying the risks and benefits of screening for individual patients. These tools increase patient knowledge and increase their ability to accurately assess risk.