BOSTON Physicians advising men whether to be screened for prostate cancer with a PSA test must rely more on available evidence when recommending screening, biopsies and treatments rather than long held beliefs that PSA-based testing is beneficial for all, Beth Israel Deaconess Medical Center prostate expert Marc B. Garnick, MD, says.
Writing in the February edition of Scientific American, Garnick states the current system that relies on prostate-specific antigens levels in the blood is "deeply flawed," and physicians must take into account the fact "the PSA test does not tell you if a man has cancer, just that he might have it."
The recent US Preventative Services Task Force's assessment of studies published in 2009 shows more harm than good results from PSA testing, and that evidence favors moving away from aggressive early treatment for all and toward a more cautious, individualized approach an approach currently underway at BIDMC.
"Most people outside the medical community do not realize how flimsy evidence has been in favor of the PSA screening data," says Garnick, who is also an editor-in-chief of Harvard Medical School's Annual Report on Prostate Diseases and associated website.
"In a perfect world, a screening test would identify only cancers that would prove lethal if untreated. Then, men who had small, curable cancers would be treated, and their lives would be saved. Ideally, the treatments would not only be effective, they would have no serious side effects. Such a scenario would justify massive screening and treatment of everyone with a positive test."
However, doctors currently do not have a reliable way to determine which of these small cancers, caught by biopsy, are potentially dangerous and which would not cause harm throughout a man's lifetime. Moreover, all of the current treatments carry significant risks and long term side effects.
Despite successfully preventing a single dea
|Contact: Jerry Berger|
Beth Israel Deaconess Medical Center