PSA screening for prostate cancer. The debate continues.

The PSA Controversy: A view from family physicians.
November 3, 2011
The PSA debate. What am I telling my patients?
November 4, 2011
Show all

PSA screening for prostate cancer. The debate continues.

ABC World News reported, “An earthquake in the debate over men and prostate cancer” regarding a “simple blood test called a PSA. Twenty million men use it to find out if they show a sign of risk, yet today, a government task force is saying healthy men should skip that test, arguing that the treatment that often follows the test may not be worth the consequences.”
On its front page, the New York Times (Subscription Publication) continued coverage of the news that the US Preventive Services Task Force (USPSTF) “found that a PSA blood test to screen for prostate cancer does not save lives, but results in needless medical procedures that have left tens of thousands of men impotent, incontinent or both.”
However, “urologists – the doctors who most often treat prostate cancer – promised to fight. The American Urological Association issued a statement saying that the recommendation ‘will ultimately do more harm than good.'”
The Los Angeles Times reported, “the task force wasn’t trying to figure out whether screening for elevated levels of a protein called prostate specific antigen would save any lives at all; the answer to that is clearly yes. Rather, the question before the 16-member panel was whether widespread PSA testing saves enough lives to justify the considerable medical fallout – Including loss of urinary control and impotence – to men whose lives are not saved by the test.”
USA Today notes that the task force’s “previous advice, in 2008, recommended against the PSA only for men 75 and older; most doctors agree that older men with undiagnosed prostate cancer are likely to die of something else.”
The Wall Street Journal (Subscription Publication) reported that the American Urological Association continues to recommend PSA screening for men who want an early diagnosis, but is in the process of creating new guidelines. The AUA said a discussion of PSA testing should include mentioning the risks involved, as well as presenting surveillance as an option.
The Los Angeles Times “Booster Shots” blog reported, “Most cases of prostate cancer are not aggressive,” and in fact, “the majority of men die with it, and from something else.”
That said, “for men who have had the disease and had their prostate removed, it can detect a recurrence. … And high-risk patients who find they have slightly elevated levels can benefit from stepping up their vigilance.”
HealthDay reported that the task force studied “five trials, the two largest done in Europe and in the United States.”
The European study “found no reduction in deaths due to prostate cancer among men of all ages in the study who underwent PSA testing. But it did find some reduction in deaths among men aged 55 to 69 who got the blood test.
“The American trial, involving almost 77,000 men followed for over a decade, also failed to show an overall reduction in deaths.”
Experts note “that the real problem, right now, is that there’s no reliable test to tell a patient” whether his tumor will be aggressive or not.
The New York Times (Subscription Publication) reported, “Insurers and clinicians scrambled on Friday to decide whether to continue to offer routine PSA tests following news that an influential panel of experts no longer recommended them for healthy men. … Aetna and Kaiser Permanente said it was unclear whether they would continue paying for the test.” United Healthcare and WellPoint said they would continue coverage.
CQ (Subscription Publication) notes, “Medicare and Medicaid need not change their coverage policy if the panel issues a final recommendation giving the PSA a D as a test for prostate cancer” according to an HHS spokesman.
Medicare “is required under a 2008 law to cover the PSA test annually for beneficiaries 50 years old and older. Presumably it would take an act of Congress to undo that coverage requirement.”
The spokesman said that “Medicaid coverage of the PSA test is a state by state decision.”

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.