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U.S. Advisers Say 'No' to Routine PSA Tests for Prostate Cancer
Date:5/22/2012

By Maureen Salamon
HealthDay Reporter

MONDAY, May 21 (HealthDay News) -- In a highly anticipated move sure to unleash heated debate, a prominent U.S. government advisory panel is recommending that men of all ages no longer be screened for prostate cancer by undergoing the prostate-specific antigen (PSA) blood test.

The U.S. Preventive Services Task Force, an independent group of medical experts in prevention and evidence-based medicine, said PSA screening results in overdiagnosis of prostate cancer and unnecessary treatment that can leave men impotent and incontinent.

This final recommendation comes seven months after the task force drafted a report giving a "D" rating for the PSA blood test. Previous guidelines had stated that most men should undergo screening beginning at age 50.

"Some may say that by rating the test a 'D' we're taking away the possibility of an informed decision, but we don't want that to be the case," said task force co-vice chair Dr. Michael LeFevre, a professor in the department of family and community medicine at the University of Missouri School of Medicine. "This decision does not preclude a man choosing to be screened."

The task force is the same panel that in 2009 rejected regular mammograms for women in their 40s, after also concluding the benefits don't outweigh the harms.

The new recommendation is published online May 22 in the journal Annals of Internal Medicine.

About 242,000 new cases of prostate cancer will be diagnosed in Americans this year, and about 28,000 will die from it, according to the U.S. National Cancer Institute. More than two-thirds of those deaths occur after age 75, the task force said.

PSA tests -- which measure prostate-specific antigen, a protein produced by the prostate gland -- can detect which men are developing the malignancy. But they cannot discern between cases that will never become life-threatening and those that require treatment, such as surgery, radiation or hormone therapy.

Basing its recommendation mainly on two major trials of PSA testing in asymptomatic men in the United States and Europe, the task force concluded screening may only help one man in every 1,000 to avoid dying from prostate cancer. Up to five in 1,000 men will die within a month of prostate cancer surgery, the panel said, and between 10 and 70 per 1,000 men will suffer lifelong adverse effects, such as urinary incontinence, erectile dysfunction and bowel dysfunction.

Many will also suffer unduly from persistent anxiety, the report said.

Critics of the task force's decision said the group underestimated the PSA test's benefits and overestimated its harms and also overlooked significant methodological flaws in the studies on which it based the "D" recommendation. None of the task force members are urologists or oncologists, making them unqualified to broach the topic, some health experts said.

"I think they're throwing away the baby with the bathwater," said Dr. William Catalona, a professor of urology and director of the clinical prostate cancer program at Northwestern University's Feinberg School of Medicine in Chicago, who wrote an accompanying journal editorial condemning the move.

"There's just no other way to detect prostate cancer early than through PSA testing," Catalona added. "If we were to completely stop PSA testing in all men . . . it would result in countless men dying of metastatic prostate cancer. People are happy to be cured of their prostate cancer, even if they have some side effects."

Dr. Otis Brawley, chief medical officer at the American Cancer Society and an outspoken figure on the pros and cons of cancer screening tests, encouraged men to make their own choice about PSA screening while keeping the risks and benefits in mind. Certain men, including blacks and those with a family history of the disease, are at significantly higher risk of developing prostate cancer, he noted.

"I am hoping this (recommendation) shuts down mass screenings, where men are only told that this will help them, which is stretching the truth," Brawley said. "They're rarely told about the potential for harm and that, for the people running the screening, the [venture] is usually quite lucrative for them."

LeFevre said it remains to be seen whether health insurers will change their coverage of PSA screening based on the task force's recommendation. For one thing, insurers aren't supposed to tailor coverage decisions to USPSTF guidelines, he said.

"If you look at the overall costs of screening, the PSA test itself is very small," LeFevre said. "I'd be surprised to see them take what I call the political risk of backing away from that."

More information

For more on prostate cancer, visit the American Cancer Society.

SOURCES: Michael LeFevre, M.D., M.S.P.H., co-vice chair, U.S. Preventive Services Task Force, and professor, family and community medicine, University of Missouri School of Medicine, Columbia; Otis Brawley, M.D., M.P.H., chief medical officer, American Cancer Society, Atlanta; William J. Catalona, M.D., professor, urology, and director, clinical prostate cancer program, Northwestern University Feinberg School of Medicine, Chicago; May 22, 2012, Annals of Internal Medicine


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