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Panel: Don't Get PSA Prostate Cancer Screen

Harm Outweighs Benefit of Routine Prostate Cancer Screening, Task Force Says
By
WebMD Health News
Reviewed by Laura J. Martin, MD

man in hospital gown

May 21, 2012 -- Men should not get routine PSA tests to screen for prostate cancer, the U.S. Preventive Services Task Force today reaffirmed.

The USPSTF is the independent panel that sets U.S. cancer-screening policy. Last October, the group released a draft report finding that men get far more harm than benefit from routine PSA tests.

That set off howls of protests from many urologists and some patient groups that strongly support routine PSA screening. Would the USPSTF back down? No. Today's final decision fully adopts the draft report.

"The task force has not changed its final conclusion," task force co-chair Michael LeFevre, MD, MSPH, tells WebMD. "Many men will be harmed by prostate cancer screening. Very few will benefit. The benefits do not outweigh the harms, and therefore we do not recommend screening."

LeFevre, professor and vice chair of family medicine at the University of Missouri, says the task force "carefully analyzed the strengths and weaknesses of each study" of PSA testing.

They concluded that for every 1,000 men who are screened with the PSA test:

  • One man will avoid death from prostate cancer.
  • One man will develop a blood clot in his legs or lungs due to treatment.
  • Two men will have heart attacks due to treatment.
  • Up to 40 men will be left impotent or unable to control urination due to treatment.

"We all want protection from prostate cancer, but our current methods of detection and screening are not enough," LeFevre says.

That goes for men at higher risk from prostate cancer, too, including African-American men and men with a family history of prostate cancer.

"African-American men are at greater risk of being diagnosed with and dying from prostate cancer. We don't know why," LeFevre says. "But we don't have any evidence that the balance of benefits and harms from PSA testing is different according to race. ... One could say similar things about men with a significant family history of prostate cancer."

PSA screening advocate Anthony D'Amico, MD, could not disagree more.

"I think men at high risk ... have the most to lose from not getting PSA tests. They are the ones who get the lethal cancers," D'Amico, professor and chief of genitourinary radiation oncology at Boston's Brigham and Women's Hospital, tells WebMD.

The final USPSTF recommendation appears in the May 21 issue of the Annals of Internal Medicine. Accompanying the report is an editorial by D'Amico, PSA pioneer and advocate William J. Catalona, MD, of Northwestern University, and several other colleagues.

"The USPSTF has underestimated the benefits and overestimated the harms of prostate cancer screening," they write. "Therefore we disagree with the USPSTF's recommendation."

PSA Test: Clinical Trials

A bone of contention between the USPSTF and its critics is how to interpret the two main clinical trials that looked at whether PSA screening prevents prostate cancer deaths.

1 | 2 | 3

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