Task Force to Men: Don't Get PSA Test
Draft Guidelines Advise Against Common Prostate Cancer Screening Test
PSA: Harm Without Benefit?
The idea of PSA screening is that it will detect early prostate cancers that can be cured. But clinical trials fail to show that PSA screening cuts prostate-cancer death rates.
"At this point we have had over 370,000 men enrolled in clinical trials, and we still do not see a significant benefit," LeFevre says. "If there is a benefit, it is very small. That is different from zero benefit, but the true benefit is somewhere between small and none."
The harm from a PSA test is that a positive test leads to a biopsy. Biopsy can detect prostate cancer -- but that's where troubles begin.
"The major problem is that most of the cancers we detect do not need to be treated, but we do not know which ones do need to be treated," LeFevre says. "And these treatments do have significant harms."
Etzioni argues that the Gleason score -- a scale used to evaluate prostate cancer severity -- tells doctors which cancers should be treated and which should not. But Lichtenfeld agrees with LeFevre that "we do not have a test to tell which cancers are indolent and which are aggressive."
Once they learn they have a prostate cancer, most U.S. men want treatment. And LeFevre notes that treatment carries very real risks.
For every 1,000 men who undergo prostate-cancer surgery, five die within a month. Another 10 to 70 men will have complications of surgery. And 200 to 300 of these men will go on to have long-term urinary incontinence, impotence, or both.
"The net result is that doctors and patients and families are going to have to have very careful conversations with their doctors that really emphasize what the scientific evidence shows," Lichtenfeld says. "And that is not overwhelmingly in favor of PSA testing."
Even though Etzioni supports PSA testing, she says only a certain group of men should seek it.
"I really think a man should go in for a PSA test if he is going to be comfortable with the notion of living with a low-risk cancer," she says. "The problem is that we as a society are not able to hear the word 'cancer' and not want to treat it. We need to understand prostate cancer better and know it is a very variable disease. There are high-risk cases that need to be treated and many, many low-risk cases that do not."