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Use of PSA Blood Test Questioned by Task Force
By Dr. David Lipschitz
Conflicting
opinions on cancer screening have caused a great deal of confusion
for health care providers and the general public. This particularly
applies to breast and prostate cancer screenings.
Most recently, the U.S. Preventive Services Task Force issued a definitive recommendation
against using the PSA blood test to screen for prostate cancer in healthy men
of any age. Even in those who are at a high risk for developing prostate cancer,
including blacks and men with a strong family history of the disease, the value
of the test is questioned.
Their recommendation is primarily based on two facts: First, the task force maintains
that the PSA does not reduce deaths from prostate cancer. Second, screening leads
to needless biopsies (as many as one million annually) and unnecessary surgeries
and radiation that frequently result in incontinence, erectile dysfunction and
other urinary and bowel problems. Many patients receive hormonal therapy to decrease
testosterone levels. This often causes fatigue, weakness, osteoporosis and a
poor quality of life.
Many urologists and cancer experts strongly oppose the notion of completely abandoning
the use of the PSA. They maintain that early detection does indeed save lives,
and worry that failure to detect prostate cancer early will lead to a far greater
number of patients who develop widespread disease throughout their body. Symptoms
include severe bone pain and fractures, neurological issues due to spread of
the tumor to the brain and many other problems.
Widely disseminated prostate cancer causes a great deal of suffering. Their point
of view is strengthened by the fact that the task force recommendation was based
on an American study that was seriously flawed with inaccurate conclusions.
Recently, an important research article was published in the New England Journal
of Medicine that attempted to weigh the potential benefits of a PSA screening
against the impaired quality of life as a consequence of further testing and
treating prostate tumors. In this study, the PSA test was measured every four
years in 1,000 men between the ages of 55 and 69.
Their analysis predicted that the PSA test would result in an increased number
of prostate cancers diagnosed, from 112 to 157 cases. But the number of deaths
from prostate cancer would decrease from 31 to 22 cases, and the number requiring
end-of-life palliative care would decrease from 40 to 26. In this study, screening
healthy men led to a 37 percent reduction in mortality from prostate cancer.
Their research also demonstrated the downside of screening, including a marked
increase in the number of biopsies. And of the 104 cancers identified, a total
of 45, or 43 percent, were over-diagnosed. In other words, prostate cancer was
diagnosed and treated despite compelling evidence that showed the tumor would
never have caused symptoms or reduced life expectancy. Quality of life was also
affected by the high risk of significant complications.
An editorial in the New England Journal of Medicine acknowledged that the PSA
test saves lives but at a high cost. The publication does not believe that definitive
information is yet available to make a concrete recommendation either for or
against PSA screening. Each patient should have a frank discussion with his physician
before a screening decision is made.
Screening practices in America are very different from Europe. Here, annual testing
is recommended. In contrast, in Sweden, men are screened every two years, and,
in Holland, every four. Deaths from prostate cancer are the same in all three
countries.
Annual screening leads to more unnecessary biopsies and more diagnoses that cause
more harm than good. And in the United States, PSA tests are measured in men
in their 80s despite the fact that there is no evidence that screenings are of
any value in men over age 70. The upper limit of the normal range for the PSA
is 4. This is the level at which a referral to a urologist should be considered.
In medicine, nothing is ever clear-cut. As I am in my 70th year, I will no longer
be screened. But at a younger age, testing should be considered if you fully
understand the potential downsides of over treatment.
This page and its contents ©2012
Metropolitan News Company, Inc.
