Prostate cancer experts bash panel's PSA test recommendation

A new study finds that the prostate cancer blood test does more harm than good. Whit Johnson reports on the reaction¬s from doctors and their male patients.

Prostate cancer blood test risky: study
A man gets a PSA test to screen for prostate cancer.
CBS

(CBS/AP) Prostate cancer specialists are pushing back against an expert panel's recommendation that healthy men shouldn't get PSA blood tests for detecting prostate cancer.

"We all agree that we've got to do a better job of figuring out who would benefit from PSA screening," said Dr. Scott Eggener, a prostate cancer specialist at the University of Chicago. "But a blanket statement of just doing away with it altogether ... seems over-aggressive and irresponsible."

The U.S. Preventive Services Task Force had examined all the evidence and found little if any reduction in deaths from routine PSA screening, but it did conclude that too many men are diagnosed with tumors that never would have killed them and suffer serious side effects because of it.

Dr. Deepak Kapoor, chairman and chief executive of Integrated Medical Professionals, which includes the nation's largest urology practice, disagreed to the New York Times, saying "We will not allow patients to die, which is what will happen if this recommendation is accepted."

The idea that finding cancer early can be more harmful than helpful is a tough one to grasp - but it's at the heart of this debate.

According to the task force, high levels of PSA in the bloodstream - or prostate-specific antigen - only sometimes signals prostate cancer. But it can also indicate an infection or an enlarged prostate, or tiny tumors that may never pose a threat. There's no way to tell in advance who needs aggressive treatment.

In fact, most men who undergo a biopsy for an abnormal PSA test don't have prostate cancer. By one estimate screening detects small tumors that will prove too slow-growing to be deadly in two of every five men whose cancer is caught through a PSA test. Treatments, including radiation and surgery, often carry significant risks of side effects. These include incontinence, impotence, or other complications that can lead to death.

"If we had a test that could distinguish between a cancer that was going to be aggressive and a cancer that was not, that would be fabulous," task force chair Dr. Virginia Moyer of the Baylor College of Medicine, said.

That task force's recommendation isn't final - it's a draft open for public debate. Clearly the debate is already under way.

"The U.S. Preventive Services Task Force is a group of primary care physicians like pediatricians and OB/GYNs who never treat prostate cancer," Dr. Herbert Lepor, professor of urology at New York University School of Medicine, told Reuters. "They have simply misinterpreted the studies and have not seen men die of this fatal disease."

About 1 in 6 U.S. men will be diagnosed with prostate cancer at some point in their life. In the U.S., about 217,000 men are diagnosed with prostate cancer each year, and 32,000 die.

Men who experience prostate cancer symptoms or have already had prostate cancer are not affected by the new recommendation.

Dr. Michael Barry of Massachusetts General Hospital, who heads the Foundation for Informed Medical Decision-Making that helps patients make their own choices, had his take on all the hubbub: "The truth is that like so many things in medicine, there's no one-size-fits-all."

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