Health experts: Routine PSA tests for prostate cancer not good for health

(CBS News) A top panel of health experts called the U.S. Preventive Services Task Force says that men should no longer get routine prostate-specific antigen (PSA) tests to screen for prostate cancer. The reason, it says, is that the tests may lead to treatments that do more harm than good.

U.S. panel recommends against PSA tests for screening prostate cancer in men of all ages

More than 33,000 American men die of prostate cancer each year. And, every year, 20 million get the PSA test to detect the disease early. The recommendation is already causing a lot of criticism. Dr. Jon LaPook reported on the issue.

For 20 years, the message has been the same: Get a PSA test every year or two, detect prostate cancer early -- and save your life. Dr. Michael Lefevre helped lead the panel that said the message was wrong.

"The problem is that in contrast to the small benefits, a significant number of men will be harmed by the test and treatments that follow prostate cancer screening," he said to CBS News.

The task force said:

The panel is among the most influential in the country. It cited an 11-year study of over 180,000 men. The study showed more than 1,000 need to be screened to detect 37 cancers and prevent a single prostate cancer death.

The options for men with prostate cancer include radiation, surgery, hormones and or simply observing. Side-effects of treatments include erectile dysfunction and urinary difficulties. Lefevre says the consequences can be even worse.

"Ultimately, we'll find that two to three men out of those 1,000 will, in fact, have a serious complication such as heart attack, stroke, blood clot or even death," Lefevre said.

The recommendation sparked fury today at the annual meeting of the American Urological Association. In a statement, the group said it was "outraged" and that the recommendation was "inappropriate and irresponsible."

"I do not believe that the medical evidence in any way supports this conclusion," Dr. Herbert Lepor, the head of urology at NYU Langone Medical Center, told CBS News.

"PSA has taken us down the road to decreasing the risk of prostate cancer deaths," he said. "We all recognize we've got a long way to go to perfect screening, but the last thing we need to do is turn back."

"We have been taught for years to fear cancer and that only hope is early detection and treatment," Lefevre said. "And so for both doctors and patients alike, it's difficult to accept that some cancers don't need to be discovered and don't need to be treated."

As for those who have a family history of prostate cancer, the panel believes that doctors can't specifically reccommend to do the test -- because it still isn't at the point where it can provide more benefits at the risk of negative consequences. But the test may be further developed, and LaPook suggested that each patient should talk to their doctor about the pros and cons of taking the PSA test.

[gabenow]

Stewart Justman wrote an e-single on this topic--the emphasis on screenings/early detection of prostate cancer, and how it can lead to over diagnosis and end up hurting patients. Very interesting read: http://******/oMiVz

[Dtraveler63]

This article really seems to be missing something or the "panel" forgot to say something. As read, the article lends itself to that a positive PSA leads straight to treatment. In my case it did not. At the age of 43 I had my first PSA test and to my surprise it was pasotive. I opted to be retest about 6 weeks later and bigger surprise, PSA higher. The doctor admitted the test wasn't an absolute certainty that I had cancer and to be certain then I could have a biopsy done. Of course I did that proved conclusive and I had surgery done to remove my cancer. No PSA, no biopsy, no surgery, no me by 50. Hear what I'm saying?

[DudleyDanoff]

As president and founder of the Cedars-Sinai Tower Urology Group in Los Angeles, I have been diagnosing and treating prostate cancer for nearly forty years. For the U.S. Preventive Services Task Force to advise that healthy men should not get routine PSA (prostate-specific antigen) testing does a distinct disservice to the many men who would have otherwise died a particularly unpleasant death from prostate cancer if they hadn't been diagnosed at an early and curable stage.

Since the PSA era, prostate cancer deaths have been reduced by more than 30 percent. Prior to PSA screening, more than 80 percent of all the prostate cancers that I personally diagnosed (usually by finding an abnormality during a digital rectal exam) were incurable.

Those of us who treat prostate cancer on a daily basis know that there are problems with the PSA and it cannot be viewed in a vacuum. An abnormal PSA does not always mean disease but warrants further evaluation by a urologist. In addition, diagnosing a cancer does not mean that it must be treated. Indeed, over the past four years, more and more patients enter the "active surveillance" or "watchful waiting" group. Interestingly, about one-third of those men demonstrate progression of their disease and require treatment.

The PSA is far from perfect, but at present it is the best marker for the early diagnosis of aggressive, organ-confined and curable prostate cancer. Let's not throw out the baby with the bath water.

Dudley Seth Danoff, MD, FACS
Cedars-Sinai Tower Urology
Los Angeles, CA

[dj4240]

This sounds like BS to me and smacks of "death panel" propaganda. Men get the test and don't buy into their crap....This is a war on men,in general and a war on the elderly in particular.

[KansasCity-2012]

We employ ambulance drivers to save lives, but if they cause fatal traffic accidents, then their benefit is questioned.

[tmwctcbs]

If there is a problem with over treatment for prostate cancer, then this is a ethics problem with the medical profession.

[KansasCity-2012]

I just went through one of these PSA test screenings just as I was passing a kidney stone. The PSA test reflected elevated PSA just before I became aware of the telltale pain that afflicted me twice in the past. I saw a urologist and went through a variety of uncomfortable and unpleasant tests. I passed the stone within the same week that I had a re-test of my PSA. After my last medical exam, I noted to the urologist that I passed a stone a week earlier. I re-tested my PSA and it returned almost back to normal.

The PSA test detects far more conditions than cancer - most which are harmless.

I am not a fan of Flomax or Rapiflo and discontinued them after feeling a serious reduction of physical gratification (lack of ejecta) during intimacy.

[OweninNJ]

The headline for this article written correctly is:
'Health Experts: Too Much Testing is Affecting our Cost Curve Template.' or 'Old Age: Overrated?'

[werntrouble]

It's well known among docs that the PSA test is erroneous. It's at best a monitor of prostate inflammation which can have many causes other than Cancer. In fact, my own doctor usually asks me if want to take the test at my annual physical and, if so, what will I do when the test turns out positive? It's the followup that is the most critical and it certainly doesn't kill you. In fact, measuring your PSA at regular intervals of time and noting the trend can be quite useful. So, if you PSA value is high to begin with and, after some antibiotics, is still trending upward, it's time to consider other more specific exams to determine if cancer is the cause.

Meanwhile, I can tell you that researchers in universities and the pharmaceutical industry are working hard to discover blood-borne biomarkers other than PSA that are much more specific to prostate cancer. Once these are identified and positively correlated with the presence of cancer, diagnostic monitoring will become an instant best-seller.

[Zann-Zel]

WHAT THE HELL IS WRONG WITH THESE PEOPLE??? : /

Are people simply not dying out fast enough for them????

MEN - GET the test! For God's Sake! Don't listen to these idiots!