Task Force to Men: Don't Get PSA Test
Draft Guidelines Advise Against Common Prostate Cancer Screening Test
"In the American Cancer Society's 2010 guidelines, we said we were uncertain: The evidence is not convincing that PSA testing works," Lichtenfeld tells WebMD. "We feel the task force came to a reasonable conclusion."
Just as women once were told that hormone replacement therapy would prevent heart disease -- until scientific studies showed that it did not -- Lichtenfeld says current evidence strongly suggests that doctors were wrong to tell men that PSA testing would protect them from dying from prostate cancer.
"Men need to know the truth," Lichtenfeld says. "We have gone through 20 years where we have had strong voices telling us PSA testing works. So there is a huge component of men who believe PSA testing has saved their lives. Now, when we say it wasn't necessarily so, that becomes a difficult conversation."
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.