Dr. Walt's Health Blog

PSA test does not reduce risk of death from prostate cancer

USA Today reported, “Screening men with the PSA test increases their chances of being diagnosed with prostate cancer but doesn’t reduce their overall risk of death, according to a large, long-running government study” published in the Journal of the National Cancer Institute.

Investigators “found that men randomly assigned to get PSA tests were 12 percent more likely to be diagnosed with prostate cancer, but no more likely to die.”

This “suggests that 12 percent of men screened with the PSA were ‘overdiagnosed,’ or diagnosed with cancer that didn’t need to be found, leading to unnecessary treatment, said co-author Philip Prorok of the National Cancer Institute, which funded the $250 million Prostate, Lung, Colorectal and Ovarian Cancer Screening trial.”

The Los Angeles Times “Booster Shots” blog reported, “It seems that increasingly effective cancer treatments may prolong men’s lives enough that the men often die from other causes, rather than the cancer itself.”

The Washington Post reported, “The new study, however, is unlikely to settle the long-running debate over the value of PSA testing, as prominent advocates of the tests said the results did not change their views.”

The Post points out that “many prostate surgeons and the American Urological Association have long argued that routine screening saves lives.”

The National Journal reminds that last year, “the US Preventive Services Task Force said that healthy men should no longer get routine PSA screening because the test causes more trouble than it is worth. The Congressional Men’s Health Caucus held a hearing to denounce the task force’s findings.”

The USPSTF “said that from 1986 through 2005, a million men got surgery or radiation treatment they didn’t need because their slow-growing tumors would never have killed them – and 5,000 of these men died soon after surgery.”

The New York Times “Well” blog reported, “Many doctors argue that the trial was seriously flawed because about half the men in the non-screening group ended up getting one or more PSA tests during the trial period, making it difficult to determine the real effect of screening.”

Following the study’s conclusion, “additional analysis also raised questions about whether certain younger, healthy men might benefit from PSA testing.”

While “only about 300 men out of the 77,000 studied ended up dying of prostate cancer, “the test appeared to have saved a few extra lives among younger men who didn’t have other health problems like diabetes or high blood pressure.”

On its website, ABC News points out, “Even medical organizations have different recommendations on prostate cancer screening.”

For instance, “the American Urological Association recommends that all men 40 and older be offered a screening test if they want it, but the American Cancer Society says while there may be some benefit to screening, it can also be harmful, so men should make an informed decision with their doctor based on personal beliefs and whether they are at risk.”

Reuters quoted the NCI’s Prorok as saying, “Men, if they’re considering screening, should be aware that there’s a possibility that there’s little or no benefit (and) that there certainly are harms to PSA screening.”

So, what do I recommend? You can find out in my blog, The PSA debate. What am I telling my patients?

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