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Published: November, 2012; Vol 9, Num 6

 

Benefits of Routine PSA Testing Questioned

"The prostate-specific antigen blood test or PSA, a screening tool for prostate cancer, has long been a standard in men's health care," says LHSFNA Management Co-Chairman Noel C. Borck. " This may change now that a government scientific and medical review panel has recommended against its routine use."


LHSFNA Management
Co-Chairman
Noel C. Borck

An elevated PSA level has been interpreted as a sign that the patient has prostate cancer. It often leads to additional testing and even surgery. But the U.S. Preventive Services Task Force (USPSTF) recently concluded that the PSA test, which has a high degree of false positives, often leads men with little chance of dying from prostate cancer to submit to surgery, radiation and chemotherapy. In addition to unnecessarily driving up health care costs, these treatments sometimes have debilitating side effects, including damage to bladder or bowel function and sexual difficulties. According to findings recently published in the New England Journal of Medicine, many men who endure these side effects could have survived without submitting to any treatment at all.

Prostate cancer is slow growing and most men with the disease can live out their lives without symptoms. The average age of diagnosis is 67. Yet, about one-third of men over the age of 40 have their PSA levels routinely checked.

The PSA test does not directly detect cancer but, rather, a protein made by the prostate. Other non-cancer conditions can also raise this protein level. The PSA result must be confirmed with painful biopsies and other tests. The Food and Drug Administration never approved the test for general use, just for men with urinary problems. However, because doctors are free to prescribe as they wish, test promoters have long encouraged healthy men to ask their physicians to order it, and many doctors do so routinely.

Neither the American Cancer Society (ACS) nor the American Society of Clinical Oncology (ASCO) promote routine PSA screening.

Some critics, including the American Urological Association, disagreed with the USPSTF's recommendation. They and many doctors believe that the screening test can benefit many men.

"No man should belittle the risk of prostate cancer, especially if he has a family history," says Borck. "Still, the data do justify routine, across-the-board screenings. The best advice is to discuss the risks and benefits of being screened with your health care provider before undergoing the PSA test."

[Janet Lubman Rathner]