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Capsules THE KHN BLOG

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

Description: http://capsules.kaiserhealthnews.org/wp-content/uploads/2011/10/hayward_prostate300.jpg

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.

 

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New Models Predict Likelihood of Erectile Function Return After Prostate Cancer Treatment

Problem still there but it helps men make better informed decisions with realistic expectations - watch video report

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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.

This story comes from our partner NPR's Shots blog.

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.

The draft recommendation, by the United States Preventive Services Task Force and due for official release next week... Click to New York Times for more…

Read earlier story:
>> Concern Is Growing That the Elderly Get Too Many Medical Tests; Little Benefit

>> Rising PSA Levels May Sometimes Lead to Negative Biopsies But Usually Means Cancer

>> Study Finds Way to ID Aggressive Prostate Cancers; Save Men from Aggressive Therapy

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 task force, 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 Times editorial 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 the evidence

He called the USPSTF’s determination “soulless” and faulted some of the evidence the group, including this Swedish study, used to make its decision.

>> Updated blog with comments.

>> American Cancer Society Comment: The Prostate Cancer Quandary

This was posted on Friday, October 7th, 2011 at 12:44 pm by Kaiser Health News.

Some of this information is reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery. © Henry J. Kaiser Family Foundation. All rights reserved.

 

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