No More PSA Testing - Why?

Prostate cancer screening with PSA test does more harm than good

(RxWiki News) Following a period of public discussion, the final official recommendation has been made to stop using the PSA test to screen for prostate cancer.

The United States Preventive Services Task Force has now officially given their final recommendation, and stated that no men should be given the PSA test, regardless of age. 

"Ask your doctor about prostate cancer screening."

While earlier recommendations as early as 2008 have said there was no evidence for using the PSA test, recommending against ever using the test goes one step further.

Some physicians believe there is still a use for the test in monitoring patients who have already had surgery for a confirmed case of prostate cancer, a purpose not discussed in the paper.

The task force said that the simple fact is that the test simply has too many false positives. Quite simply, the panel states, the effects of surgery, radiation, and drugs cause more suffering than missing the cancers does. Cost was not a factor considered in their final decision.

The task force used two major studies to make their final decision, one from the United States where no mortality reduction was observed when screening with PSA was used, and a second trial in seven countries across Europe, where only two countries showed any reduction at all, at one death prevented per thousand men screened.      

The task force found that for that best possible scenario of one life saved per thousand tested with PSA, another five would die within one month due to complications of surgery.

Another 70 men out of the thousand tested would lose the ability to control their bowels or bladder, or have permanent erectile dysfunction due to surgery, radiation, or chemotherapy.

One urologist went on record disagreeing with the task force. William J. Catalona, MD, Medical Director of the Urological Research Foundation stated in an accompanying editorial in the journal that Task Force recommendation has underestimated the benefits and overestimated the harms of prostate cancer screening.

Dr. Catalona states that the task force does not include urologists or even cancer specialists, and the studies mentioned are flawed in design and in practice. 

Furthermore he argues the task force ignores the complications and suffering of those living with advanced cancer. He believes that these new recommendations will take Americans back to an era when prostate cancer was often discovered at advanced, incurable stages. 

In a second accompanying editorial, the chief medical officer of the American Cancer Society, Otis Brawley, MD, says that over-diagnosis makes people think their lives were saved simply because they were treated for cancer. 

Statistically, many men with prostate cancer will succumb to another illness before they ever see any symptoms from their prostate cancer.

“Many people have a blind faith in early detection of cancer and subsequent aggressive medical intervention whenever cancer is found,” wrote Dr. Brawley. “There is little appreciation of the harms that screening and medical interventions can cause.”

The task force has been taking opinions into consideration since October 2011, when the first draft was posted. Before that time, the official recommendation was for physicians to give the test to patients who insist on a PSA screening.

Now the task force has finalized their recommendation, saying data over the last few years shows clearly that the harm of over-treatment outweighs the benefits.

Yet the recommendation is only that, a recommendation. While the patient always has the right to veto, the final decision on whether to use PSA is still the doctor's to make.

The final recommendation of the task force, and accompanying editorials were published online on May 22, 2012 in The Annals of Internal Medicine.

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Review Date: 
May 19, 2012