Dr. Vipul Patel directed robot arms that were performing prostate cancer surgery at Florida Hospital in Celebration, Fla.
Chris Garlington, New York Times
Men are advised to skip routine PSA tests
- Article by: BRIAN VASTAG
- W ashington Post
- May 22, 2012 - 6:03 AM
Men should no longer receive a routine blood test to check for prostate cancer because the test does more harm than good, a top-level government task force has concluded in a final recommendation that immediately became controversial.
The recommendation Mon-day from the U.S. Preventive Services Task Force runs counter to two decades of medical practice in which many primary-care physicians give the prostate-specific antigen (PSA) test to healthy middle-aged men.
But after reviewing scientific evidence, the task force concluded that such testing will help save the life of just one in 1,000 men.
At the same time, the test steers many more men who would never die of prostate cancer toward unnecessary surgery, radiation and chemotherapy, the task force concluded.
For every man whose life is saved by PSA testing, another one will develop a dangerous blood clot, two will have heart attacks and 40 will become impotent or incontinent because of unnecessary treatment, the task force said.
Many middle-aged men regularly get the PSA test. But for years, some experts have questioned whether such screening really saves lives. Monday's statement finalizes a draft recommendation made by the task force last fall.
While not a mandate, the group's statements have widespread impact, especially on private insurers and Medicare.
Effect in Minnesota
In Minnesota, some of the largest health plans said they still cover PSA tests as part of routine screening. That won't change right away, they said, but the new guidelines will shape the debate over whether to keep paying for it.
"The tone will certainly change significantly, because this evidence suggests that it does more harm than good," said Dr. Pat Courneya, medical director at HealthPartners. "That's a significant shift, and I think it justifies careful attention."
At the same time, he acknowledged, "It's a tough conversation to have when there's been a lot of public sentiment or public belief built up that this is something that you do when you're taking good care of yourself."
Tamara Jett, founder and president of the Minnesota Prostate Cancer Coalition, said she was "very alarmed" by the guidelines. "They're basically not giving any credence to the PSA test," said Jett, of Ham Lake. "The PSA isn't perfect. It isn't the greatest tool. [But] right now, it's the only tool that men have."
Jett, whose father developed prostate cancer 12 years ago, worries that without the PSA test, men won't learn they have cancer until it's too late.
Courneya, of HealthPartners, said he knows it's an emotional discussion for many. But research shows that "the benefits are very, very small, if they exist at all, and the harms are very significant," he said. "That's a sad thing to come to conclude. But we can't ignore the fact that that's the conclusion."
Virginia Moyer, chairwoman of the federal task force and professor of pediatrics at the Baylor College of Medicine in Houston, said of her panel's finding: "It's a tough message."
She added: "Our recommendation is not a recommendation to tell the patient to shut up and go away if they ask about" PSA testing. "Our recommendation is that it not be routinely offered."
'Outraged' and 'appalled'
Specialists who diagnose and treat prostate cancer reacted swiftly. The American Urological Association said it was "outraged" by the recommendation. "Men who are in good health and have more than a 10-15 year life expectancy should have the choice to be tested and not discouraged from doing so," according to the group's statement.
The Large Urology Group Practice Association, which represents 1,800 urologists, said it was "appalled" and called the recommendation "irresponsible and inexplicable."
Reaction from physicians who say prostate cancer is overdiagnosed was positive. "This recommendation is a huge win for men," said Georgetown University's Kenneth Lin, a physician who has studied PSA screening.
PSA tests do not directly detect cancer -- they detect a protein made by the prostate. Conditions other than cancer, including benign growth of the prostate, can raise PSA readings, leading to painful biopsies and other invasive tests.
The Food and Drug Administration has never approved PSA testing for the general population. But physicians are free to use the test however they choose.
Staff writer Maura Lerner contributed to this report.
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