Panel rejects PSA prostate screening
Doctors should no longer offer the PSA prostate cancer screening test to healthy men, because they're more likely to be harmed by the blood draw -- and the chain of medical interventions that often follows -- than be helped, says the final report from a government advisory panel that's already sparking controversy among medical groups.
Even after studying more than 250,000 men for more than a decade, researchers have never found the PSA to save lives, according to the U.S. Preventive Services Task Force, a panel of doctors that advises the government on cancer screenings and other ways to avoid disease.
Yet the PSA can cause harm, by leading to unnecessary treatments and their side effects, says task force chairwoman Virginia Moyer, a professor of pediatrics at Baylor College of Medicine in Houston. "Our current approach to screening for prostate cancer does not serve men well," Moyer said in a statement.
Many doctors and patients sharply criticized the task force's decision, in an echo of the uproar that broke out after the panel's 2009 recommendation to limit mammograms to older women. The American Urological Association said it is "outraged" at the new guidelines, calling them "inappropriate and irresponsible" in light of the 28,000 prostate cancer deaths each year.
Doctors aren't required to follow the recommendations, and both sides agree men are likely to continue asking for the tests. Federal legislation requires Medicare to continue to pay for the PSA. Private insurers usually follow Medicare's example. The panel didn't consider cost in its deliberations, Moyer says.
Criticism of the PSA has been growing for years, with doctors such as the American Cancer Society's Otis Brawley calling attention to the harm caused by "overtreating" early cancers. Brawley notes that many prostate tumors grow so slowly that men die of other ailments long before their cancers would ever threaten their lives. Up to 60% of prostate tumors fall into this category, and they are better left undetected.
Treatment can even be deadly: One in 200 men who have prostate surgery die shortly after the procedure, Moyer says.
The recommendation, first released as a draft in October, applies to healthy men of any age, although not for those who already have been diagnosed with prostate cancer.
Moyer agrees that men desperately need a better test. Unfortunately, there are no better tests with which to replace the PSA, such as rectal exams or ultrasounds, says Ian Thompson, chairman of urology at the University of Texas Health Science Center at San Antonio.
Thompson says the task force went too far in rejecting the PSA completely. He also says he doesn't want to go back to the "bad old days" before screening, when doctors found prostate cancer only after it had become incurable.
Terry Dyroff, 66, of Silver Spring, Md., says he realized the PSA's risks five years ago, after a biopsy led to a life-threatening bloodstream infection. He hasn't had a PSA since. If he develops prostate cancer, he says, "I'd rather not know."
Asking the experts, 5D
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