Here We Go Again: Men Should Not Get PSA Test
Men should not get routinely screened for prostate cancer using the PSA test, a government panel recommends. The panel finds that there is little evidence that testing for PSA saves men’s lives, while causing too much unnecessary harm from the treatment of tumors that would never have killed them.
Time magazine reports that the advice, published in the Annals of Internal Medicine, extends the recommendation against routine prostate cancer screening to men of all ages; the group had previously advised men aged 75 and older to avoid PSA testing.
The panel’s conclusion may be confusing to patients and physicians in part because they have likely assumed that previous clinical recommendations for prostate-cancer screening were based on extensive and solid scientific studies. In reality, PSA screening had not been fully evaluated for its survival benefits. Most previous studies had focused on five-year survival rates: although men who got PSA testing were more likely to survive five years after being diagnosed, compared with those who did not get screened, PSA testing does not necessarily extend their lives overall.
That distinction is important since it means that early detection is not necessarily better. Rather, PSA testing could result in many men being over-diagnosed with prostate cancer. That’s especially problematic for prostate tumors, since they grow very slowly in many cases and don’t cause health problems for older men. Most doctors say that many men die with prostate cancer, not from it.
The Philadelphia Inquirer reports that one of the most vocal critics of routine testing — Richard J. Ablin, who discovered the prostate-specific antigen in 1970 — was jubilant. For decades, he has said that using the blood protein to try to flag cancer in the reproductive gland is “hardly more effective than a coin toss.” He says the test should be reserved for monitoring prostate cancer patients for recurrence after treatment.
- Physicians News Digest