PSA Tests for Prostate Cancer: More Harm Than Good?

Oct 7, 2011 1:32pm

ABC News’ Roger Sergel and Dan Childs report:

Once again, the public is faced with a critical health issue over which the medical community has split.

On Friday, the U.S. Preventive Services Task Force publicized its recommendation that healthy men should no longer receive PSA blood tests for prostate cancer as part of routine cancer screening. The government panel’s recommendation supports the growing notion that the blood tests often do more harm than good.

The blood test is designed to detect higher than normal levels of prostate-specific antigen, or PSA, in the blood. A high level can signal prostate cancer, but it can also indicate more benign conditions. A positive PSA test can lead to invasive biopsies, which come along with their own raft of considerations, including impotence and incontinence.

The full version of the USPSTF’s guidelines can be read here.

“We have put a huge amount of time, effort and energy into PSA screening and that time, effort and energy, that passion, should be going into finding a better test instead of using a test that doesn’t work,” Dr. Virginia Moyer of the Baylor College of Medicine, who heads the task force, told The Associated Press Thursday.

Science appears to support the recommendation. The USPSTF outlined in a report published early in the Annals of Internal Medicine that an analysis of the five largest studies on PSA testing suggested that the benefits of such tests appear minimal, while the downsides are considerable.

Still, some doctors worry that the recommendation could add to public confusion over the true benefits of screening tests that, in the past, they may have been encouraged to seek out. And it’s an issue that is not limited to prostate cancer screening; the USPSTF in 2009 recommended against annual mammograms for women age 40 to 49 because, they said, the benefits of testing do not outweigh the harms.

“The public often feels frustrated with the seeming ‘mixed messages’ that come from the medical establishment,” Dr. Jehan El-Bayoumi, residency director at George Washington University, told ABC News. “One minute we’re telling people to get screened, the next minute we’re telling people that it doesn’t make a difference. And so, no wonder the public is confused.”

Indeed, there is currently no overarching consensus on PSA testing. Dr. Pat Walsh of Johns Hopkins University, a world-renowned urologist and pioneer in nerve-sparing prostate surgery, called the updated recommendation “a shame.”

“This decision ignores the fact that there has been a 40 percent reduction in prostate cancer deaths over the past 10 years since PSA testing has been in place,” Walsh said. “The USPSTF ignores this because it relies only on randomized trials, and there are a number that have too short a follow-up and other serious deficiencies.”

Dr. Leonard Gomella, chairman of urology at Thomas Jefferson University, called the decision an “appalling affront to all men who will die from prostate cancer.” Dr. William Catalona, director of the Clinical Prostate Cancer Program at Northwestern Memorial Hospital, said, “The extent to which PSA screening causes over diagnosis and overtreatment is exaggerated.”

“I have to wonder whether economics are playing a role in the decision of the Task Force,” said Dr. Jerome Richie, chief of urology at Brigham and Women’s Hospital.

And Dr. Bruce Chabner, clinical director of the Massachusetts General Cancer Center, who underwent treatment for prostate cancer detected at age 59, said the test may have been crucial in his case.

“Would I still be alive and free of disease without PSA and treatment? I don’t know, but I suspect that at the very least I would not be free of metastatic disease,” Chabner said.

Several nonurologists, however, applauded the USPSTF’s move.

“I think this recommendation is long overdue,” said Dr. Thomas Schwenk, dean of the University of Nevada School of Medicine.

“This advisory mirrors my advice to patients over the last 10 years,” said Dr. William Golden, professor of medicine and public health at the University of Arkansas for Medical Sciences. “I have long believed that prostate cancer had a cure worse than the disease.”

“People have a need to believe, a need to feel that we have some power over this terrible disease,” said Dr. Lee Green of the University of Michigan. “Admitting the truth, that PSA screening doesn’t really save lives, is unacceptable because it takes that away. It’s scientifically correct, and will provoke a firestorm.”

Of course, only time will tell whether the new USPSTF recommendation will be accepted by the medical community at large. Indeed, many hospitals ignored the panel’s recommendation on mammograms when they came out, and in December 2009 senators introduced an amendment to fledgling health care legislation that maintained insurers should continue to cover mammograms in the 40-49 age group, contrary to the USPSTF’s recommendation.

But the question of where this leaves patients – many of whom will no doubt find themselves sifting through opposing professional viewpoints on their health choices – is still largely up in the air.

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