Influential Panel Giving Thumbs Down To Routine PSA Test for Prostate Cancer
See links to other comments and reports on this recommendation
By Scott Hensley, NPR News
Chicago attorney Tom Hayward suffered a raging infection after a prostate biopsy. He had to be
hospitalized, but has since recovered. (Photo by Icoi Johnson for NPR)
Oct. 10, 2011 - The same group that caused a ruckus by recommending against mammograms for women in their 40s is about to
tell men that a routine blood test for prostate cancer does most of them more harm than good.
The problem is that the test doesn’t do enough to save lives and subjects many men to additional tests
and surgery. The side effects, including impotence and incontinence, outweigh the benefits for men in good heath, according to reports about
the findings of the U.S. Preventive Services Task Force.
An independent group of medical experts, the USPSTF is in the business of grading the evidence for common
tests and procedures. Under the auspices of the Agency for Healthcare Research and Quality, the
group’s decisions increasingly serve as
guidelines for what doctors do and what insurers and the government will pay for.
The USPSTF has been working on the PSA test for a while. In fact, the group had pretty much reached a
decision in 2009 that the evidence for routine PSA testing should be graded “D” (which constitutes a recommendation against the service),
according to an article coming
in The New York Times Magazine this Sunday and already posted online.
But the controversy such a recommendation is sure to cause led to a postponement of votes on it, Shannon
Brownlee and Jeanne Lenzer report in the story.
More Key Links
U.S. Panel Says No to Prostate Screening for Healthy Men
By Gardiner Harris,
New York Times
10/7/11 - Healthy men should no longer receive a P.S.A.
blood test to screen for prostate cancer
because the test does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence in many, a key government health panel has decided.
Now it’s finally coming out, perhaps as early as today. “The harms studies showed that significant
numbers of men — on the order of 20 to 30 percent — have very significant harms,” pediatrician
Virginia Moyer, chairwoman of the
told the Washington Post.
This year, about 241,000 cases of prostate cancer are expected to be diagnosed,
according to estimates from the American Cancer Society. About 34,000 men will die from it. More than 20 million U.S. men have
their PSA’s tested each year.
A federally funded study
presented at a meeting of urologists this spring found that, overall, early surgical removal of the
prostate was no better than waiting to see how the cancer would progress. And there were more side effects among men who had surgery.
In a Timeseditorial published in March, Dr. Richard Ablin, who discovered prostate specific antigen, lamented the
overuse of the test. Yes, the test has its place, he wrote, to monitor men after treatment for prostate cancer and in screening men whose
family histories put them at high risk.
“But these uses are limited,” Ablin concluded. “Testing should absolutely not be deployed to screen the
entire population of men over the age of 50, the outcome pushed by those who stand to profit.”
While the USPSTF’s decisions carry a lot of weight, a
separate report out today shows the limits of its ability to change medical practice. The Center for
Public Integrity finds that 40 percent of Medicare spending on cancer screenings, or about $1.9 billion over five years, is wasted on tests,
including PSA, for people older than the cutoff recommended by the USPSTF.
Opposition to a change in PSA recommendations is certain. Dr. Benjamin Davies, a urologist and cancer
specialist at the University of Pittsburgh Medical Center, tweeted this morning:
the data for screening healthy patients <65 is strong, not debatable, and level 1. Hard to tweet all of
He called the USPSTF’s determination “soulless” and faulted some of the evidence the group, including
this Swedish study, used to make its