The news that a key advisory board to the federal government might recommend against routine prostate cancer screening in healthy men is already setting off a firestorm of controversy and confusion. After all, the PSA blood test has become a standard part of the routine checkup for men, and millions believe it has saved their lives. Yet evidence for the test’s benefits has been on the decline for years, and concerns that it leads to unnecessary treatment that leaves many men impotent, incontinent, or both, have been on the rise.
The U.S. Preventive Services Task Force—an independent group supported by the U.S. Department of Health and Human Services that develops recommendations on preventive heath care—is expected to release early next week draft recommendations against routine screening for prostate cancer for healthy men of any age. While the test had become standard practice for many men, especially after age 50, the Task Force had previously recommended against the test for men 75 and older, and said that there was not enough evidence to make a recommendation for or against the test in younger men.
For many people, the new advice seems to go against common sense. How can a test that detects cancer early possibly not be worthwhile? Here’s why.
It turns out that many men—perhaps a third of those between the ages of 40 and 60 and most of those 85 and older—have some cancer cells in their prostate gland. But most of those cancers are not aggressive and remain confined to the gland. And the PSA blood test, as well as follow-up biopsies, can’t identify which of those cancers are aggressive and which are not. As a result, millions of men get treated unnecessarily with surgery, radiation, or hormones—and end up experiencing complications from those procedures, sometimes devastating ones. The test might not even benefit men who do have fast-growing cancer, since it’s still unclear whether early treatment works against such disease.
Indeed, a number of recent studies have failed to find that routine PSA screening saves lives, but do show that it often prompts treatments that lead to a large number of serious complications.
John Santa, M.D., director of the Consumer Reports Health Rating Center, says the controversy highlights an ongoing problem faced by consumers:
Once again consumers must sort out many years of mixed messages, biased information, and promotion to determine what is credible, independent analysis of the evidence. We must be wary of tests and treatments that seem simple but have far reaching downstream risks with modest benefits to only a few. But we should be grateful that controversy is shining a light on health matters that consumers should be actively involved in.
The Task Force’s recommendations are often followed by physicians. And the Affordable Care Act will make its findings even more important, as the law requires that insurers fully cover any screening test that it recommends but not those it doesn’t.
Bottom line: We will carefully review the Task Force’s draft recommendation when it is officially released next week. In the meantime, we stick with our long-held advice that men 75 and older generally forgo PSA testing, and that others carefully weigh the tests’ unproven benefits against its clear risks before agreeing to undergo it.
Read more about the PSA controversy and the uncertain evidence.
U.S. Panel Says No to Prostate Screening for Healthy Men [The New York Times]