Task force recommends “D” rating for PSA screening for prostate cancer

TV and print media have extensively covered the US Preventive Services Task Force’s (USPSTF) decision to give a “D” rating to PSA testing. What’s this mean for men? I’ll cover this controversy in the next few blogs.

The panel made the decision to give its LOWEST rating to PSA screening for prostate cancer because “it leads to too many unnecessary further tests and treatments.”

The Wall Street Journal (Subscription Publication) reports that according to the USPSTF’s website, the “D” rating indicates “moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.”

The PSA blood test (that stands for prostate specific antigen) has become more and more controversial over the past decade, because it is notoriously poor at identifying cancer. … It’s not the PSA test itself but the treatment that results from the test that can cause serious side effects like incontinence, sexual dysfunction and other problems.

The concern is that the test could be elevated even with benign problems like inflammation or enlarged prostate and once you have the elevated test it leads you to a biopsy, unnecessary treatment. As we talk about economics, it comes back to not hurting the patient, not spending undue money.

On its front page, the New York Times (Subscription Publication) lists some “devastating consequences of the biopsies and treatments that often flow from” PSA testing.

“From 1986 through 2005, one million men received surgery, radiation therapy or both who would not have been treated without a PSA test, according to the task force. Among them, at least 5,000 died soon after surgery and 10,000 to 70,000 suffered serious complications. Half had persistent blood in their semen, and 200,000 to 300,000 suffered impotence, incontinence, or both.”

The scientific backing for this rating was published in the Annals of Internal Medicine, and a manuscript is also available on Cancer Letter.

The Washington Post reports, “Task force chairwoman Virginia Moyer said the group based its draft recommendations on an exhaustive review of the latest scientific evidence, which concluded that even for younger men, the risks appeared to outweigh the benefits for those who are showing no signs of the disease.”

The AP explains that high PSA can signal cancer as well as “a benign enlarged prostate or an infection. Worse, screening often detects small tumors that will prove too slow-growing to be deadly. And there’s no sure way to tell in advance who needs aggressive therapy. … One study estimated two of every five men whose prostate cancer was caught through a PSA test had tumors too slow-growing to ever be a threat.”

This recommendation is both complex and controversial, so I’ll post two more posts tomorrow about the debate. And, I’ll tell you what I’ll be recommending to my male patients.