In October, we reported that the U.S. Preventive Services Task Force was recommending that routine screening for prostate cancer be suspended for most men. Last week, after six months of reviewing nearly 3,000 public comments, the task force confirmed its initial finding.
The discussion of prostate screening for cancer, as well as that of routine mammography, have helped raised consciousness that overtesting and overtreatment compromise the quality of health care.
The task force’s study was published in the Annals of Internal Medicine.
The PSA test, in which blood is tested for the presence of elevated levels of an enzyme that helps liquefy semen, exposes men to far more harm than it helps. Although elevated levels can indicate the presence of a cancer, research studies have shown that, at best, one life is saved for every 1,000 people screened over a 10-year period. But more than 100 of those 1,000 men will produce suspicious results when there is either no cancer or a cancer that is growing so slowly (or not at all) as to produce no threat. Forty of those 1,000 patients will become impotent or suffer urinary incontinence.
For most men, a positive test means having a biopsy, which carries its own risks such as pain, fever, bleeding, infection and hospitalization. If cancer is detected, 9 in 10 men will be treated surgically or by radiation even when the tumors are not life-threatening. The possible side effects are impotence, urinary incontinence, blood clots and other harms that the panel concluded are overwhelmingly persuasive in removing the PSA test from routine care.
Men concerned about prostate health and age-related problems such as reduced or intermittent urinary flow, should discuss them with their doctor for diagnosis and treatment other than PSA testing. The scientific evidence is overwhelming that it causes more harm than good -- for most men, and that means it's still worth a discussion to find out if you're in the group that may need closer watching.
