Final advice: Panel against routine prostate test

May 21, 2012 By LAURAN NEERGAARD , AP Medical Writer

Healthy men shouldn't get routine prostate cancer screenings, says updated advice from a government panel that found the PSA blood tests do more harm than good.

Despite strenuous protests from urologists, the U.S. is sticking by a contentious proposal it made last fall. A final guideline published Monday says there's little if any evidence that PSA testing saves lives - while too many suffer impotence, incontinence, heart attacks, occasionally even death from treatment of tiny tumors that never would have killed them.

The guideline isn't a mandate. The task force stresses that men who want a still can get one, but only after the doctor explains the uncertainties. That's in part because the panel found PSA testing hasn't been studied adequately in and those with in the family, who are at highest risk of the disease.

The Obama administration said Monday that Medicare will continue to pay for PSA screenings, a simple . Other insurers tend to follow Medicare's lead.

"This is important information for the public and men to have, and they should talk with their doctors about the risks and benefits of and make the decision that's best for them," said Mark Weber, a spokesman for the Department of Health and Human Services.

The task force advice goes a step further than major health groups including the , which has long urged that men decide the issue for themselves after being told of PSA's pros and cons. But it's not likely to end an annual ritual for many men 50 and older. After all, the same task force has long urged men over 75 to skip , and research suggests almost half of them still get tested.

The controversy will end only with development of better tests - to finally tell which men's tumors really will threaten their lives, and who will die with prostate cancer rather than from it, said Dr. Virginia Moyer of the Baylor College of Medicine, who heads the task force.

"We have been told for decades to be terrified of cancer and that the only hope is early detection and treatment," she said. The reality: "You don't need to detect all cancers."

"We don't want this to be the answer," Moyer added. "We want to screen for the ones that are going to be aggressive, manage those early - and leave everyone else alone."

In an editorial published with the guideline in Annals of Internal Medicine, some urologists argue the panel underestimated PSA's value and overestimated its harms.

"What PSA screening offers the men is a substantial opportunity to avoid dying a particularly unpleasant death from prostate cancer," said editorial co-author Dr. William Catalona of Northwestern University, who pioneered the testing.

He spoke Monday from a meeting of the American Urological Association, where doctors debated the guideline's impact. The urology association advises that men be informed of the potential risks and benefits before screening.

But Dr. Otis Brawley, the American Cancer Society's chief medical officer, welcomed the task force's recommendation. He hoped it would help deter mass screenings, where men are given free PSAs at shopping malls and sports arenas without being told of the controversy, screenings that Brawley calls big business when health centers profit from the follow-up care.

"The question is, are we actually curing anybody who needs to be cured right now?" Brawley asked.

Too much PSA, or prostate-specific antigen, in the blood only sometimes signals prostate cancer is brewing. It also can mean a benign enlarged prostate or an infection. Only a biopsy can tell. Most men will get prostate cancer if they live long enough. Some 240,000 U.S. men a year are diagnosed with it, most with slow-growing tumors that carry a very low risk of morphing into the kind that can kill.

To evaluate whether routine screening saves lives, the task force analyzed previous research, focusing in particular on two huge studies in the U.S. and Europe. The panel's conclusion:

-Without screening, about 5 in every 1,000 men die of prostate cancer over 10 years. The European study found PSA testing might prevent one of those deaths, while the U.S. study found no difference.

-Of every 1,000 men screened, two will have a or stroke from resulting cancer treatment, and 30 to 40 will experience treatment-caused impotence or incontinence.

-Of every 3,000 men screened, one will die from complications of surgery.

Both the U.S. and European studies have flaws, and task force critics argue over which are most believable. And while U.S. death rates from prostate cancer have dropped over 20 years, the cancer society's Brawley says the drop began before PSA testing became widespread. Moreover, the risk of death is the same in Europe and the U.S. even though many more American men are screened, diagnosed and treated, he said.

"We need to do a better job of using PSA wisely," said Dr. Scott Eggener, a University of Chicago prostate cancer specialist who was disappointed the task force went so far. "Most people would agree that a well-informed, young, healthy patient should have the opportunity to talk about it with their physician."

But he's studying a way beyond the screen-or-not controversy: Having men with small, low-risk tumors postpone treatment in favor of "active surveillance," keeping close watch on their tumors and treating only if they grow. More than 100,000 men a year are candidates, concluded a recent meeting at the National Institutes of Health.

That approach could "maximize the benefits of screening," Eggener said.

Explore further: New prostate cancer test advice overturns dogma

More information: Task force information: http://www.uspreventiveservicestaskforce.org/recommendations.htm

Journal's patient summary: http://bit.ly/LbhSxH

shares

Related Stories

New prostate cancer test advice overturns dogma

October 7, 2011
(AP) -- Men finally may be getting a clearer message about undergoing PSA screening for prostate cancer: Don't do it.

Recommendation against PSA test goes too far: expert

October 12, 2011
(Medical Xpress) -- A draft recommendation by the U.S. Preventive Services Task Force calling for an end to routine PSA testing for healthy men age 50 and older goes too far, says a prostate cancer expert at the Siteman Cancer ...

PSA test valuable in predicting biopsy need, low-risk prostate cancer

October 21, 2011
The prostate-specific antigen test, commonly known as the PSA test, is valuable in predicting which men should have biopsies and which are likely to be diagnosed with low-risk prostate cancer, a Mayo Clinic study has found. ...

Final word: Task force recommends against PSA-based screening for prostate cancer

May 21, 2012
Following a period for public comment, the United States Preventive Services Task Force (USPSTF) released its final recommendation for prostate cancer screening. The Task Force now recommends against PSA-based screening for ...

PSA screening to detect prostate cancer can be beneficial to younger and at-risk men: study

May 7, 2012
Screening younger men and men at risk of prostate cancer can be beneficial in reducing metastatic cancer and deaths and should not be abandoned, states an article published in CMAJ (Canadian Medical Association Journal).

Recommended for you

New approach attacks 'undruggable' cancers from the outside in

January 23, 2018
Cancer researchers have made great strides in developing targeted therapies that treat the specific genetic mutations underlying a patient's cancer. However, many of the most common cancer-causing genes are so central to ...

Study: Cells of three advanced cancers die with drug-like compounds that reverse chemo failure

January 23, 2018
Researchers at Southern Methodist University have discovered three drug-like compounds that successfully reverse chemotherapy failure in three of the most commonly aggressive cancers—ovarian, prostate and breast.

'Hijacker' drives cancer in some patients with high-risk neuroblastoma

January 23, 2018
Researchers have identified mechanisms that drive about 10 percent of high-risk neuroblastoma cases and have used a new approach to show how the cancer genome "hijacks" DNA that regulates other genes. The resulting insights ...

Enzyme inhibitor combined with chemotherapy delays glioblastoma growth

January 23, 2018
In animal experiments, a human-derived glioblastoma significantly regressed when treated with the combination of an experimental enzyme inhibitor and the standard glioblastoma chemotherapy drug, temozolomide.

Researchers identify a protein that keeps metastatic breast cancer cells dormant

January 23, 2018
A study headed by ICREA researcher Roger Gomis at the Institute for Research in Biomedicine (IRB Barcelona) has identified the genes involved in the latent asymptomatic state of breast cancer metastases. The work sheds light ...

Boosting cancer therapy with cross-dressed immune cells

January 22, 2018
Researchers at EPFL have created artificial molecules that can help the immune system to recognize and attack cancer tumors. The study is published in Nature Methods.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.