After at least two decades of touting it as the gold standard for prostate screening, the medical establishment appears to be turning its back on the popular PSA test.
In a May 2012 statement from the U.S. Preventive Services Task Force (USPSTF), co-chair Michael LeFevre, M.D., said that “men deserve to know what the science tells us about PSA screening: there is a very small potential benefit and significant potential harms.”
This pretty much has been my stance all along! Keep reading and see why the PSA test has been such a disaster…
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The government group is now saying that the ‘cons’ of having the test generally outweigh the ‘pros’ for most men under age 75.
The ‘cons’ are nasty indeed: If this unreliable test indicates a man may have prostate cancer, the next step is a biopsy. This is a highly invasive test in which small samples of tissue are cut out of the organ to be examined for cancer cells.
A biopsy can result in pain, fever, bleeding, infections and problems urinating. Worst of all, if cancer cells are actually present, it can spread them.
After all this risk and discomfort, the biopsy will often show no cancer is present — because the PSA test that prompted the biopsy in the first place is so often wrong.
And what if you DO have cancer?
Let’s suppose the biopsy does find cancer. What then? The most likely next steps are surgery or radiation. You might think, “Wonderful, the PSA test led to early detection and treatment!”
Not so fast. Most prostate tumors are pretty harmless. Surgery and radiation are NOT needed. The best option is to do nothing. So, in reality, the PSA test has led to overtreatment. And the treatments can lead to lifelong incontinence or impotence, not to mention a lot of pain, expense, lost work days and who knows what else.
Well, actually, we do know what else: the fear, stress and anxiety of worrying about a cancer that didn’t pose a threat.
Each year about 1,000 to 1,300 men die from complications connected to treatments that took place because the victims had a high PSA score.
As I’ve written in this space before, only about one prostate cancer out of ten is aggressive and therefore life-threatening. In a large study called the Prostate Cancer Prevention Trial, only 28% of men in their 60s who had a high PSA score turned out to have cancer as shown by a biopsy — slightly more than one man out of four.
The rest — 72 out of a hundred — had a high PSA score, but NO CANCER.
And of those who had cancer, only about one out of ten died of it. To be exact, 3 died out of every 28 men whose biopsies showed cancer. And don’t forget, that’s 3 out of the 100 who had a high PSA score at the beginning of this whole mess.
I want to underscore this: Out of a hundred men with a high PSA score only 28 had cancer and only three died of it.
This test is all but worthless, and that’s what the U.S. Preventive Services Task Force now confirms. The USPSTF reviewed previous research on this subject, including two large studies in the U.S. and Europe. When they compared men who were routinely screened with the PSA test and those who were not, there was no difference in death rates over a ten-year follow-up.
Again, I want to underscore this: Men who were tested like the dickens for prostate cancer were just as likely to be six feet under a decade later as those who weren’t tested at all.
Now, there’s a curious twist to this story. Most studies have focused on five-year survival rates, and found that PSA-screened men ARE more likely to survive more than five years. Why doesn’t that hold up when you look at a ten-year time frame?
All you get is more years of worry
It’s actually simple, when you think about: Finding cancer earlier means you live longer knowing you have it.
Consider an example: If John Smith died of cancer in 2010 and it was first diagnosed in 2006, he’s not a five-year survivor. But say he had a PSA test in 2003 and a biopsy then detected cancer. He still dies in 2010 — but, bingo! Now he’s a seven-year survivor!
And that’s exactly why the PSA test, biopsies and aggressive treatment are trumpeted as increasing five-year survival rates. The men do NOT live longer. They die at the same time they would have anyway. But the cancer is detected earlier and in the official records those men beat the five-year mark.
When the USPFTF focused on ten-year survival rates, they exposed this bogus claim of success, and the PSA test was revealed to be almost worthless.
The group advocates putting a halt to PSA screening tests unless a person “makes the personal decision that even a small possibility of benefit outweighs the known risk of harms.”
The panel said the best option would be to pursue better testing and treatment options. Clearly, what’s needed most is a test to identify aggressive cancers and distinguish them from slow-growing cancers that — in men over 60 — could be left untreated. There’s some action on this front, but no reliable test yet, as far as I know.
Watch the trend, some doctors say
Supposedly there IS a way to get some good out of the PSA test — observe the trend over a series of tests. If you’re tested every six months and the PSA score is trending up, some doctors say it indicates an aggressive cancer may be present. Biopsies and more aggressive treatment may be warranted.
Quite a few urologists and oncologists are now working on this assumption, but I don’t know how much evidence there is to support it. For what it’s worth, I have a dog in this fight. My PSA number is slightly elevated and increased very slightly over the past year. I’m not alarmed, but I’ll get tested again in six months and see if there’s an uptrend.
It’s called “watchful waiting” — and it’s by far the most sensible strategy for most men who have a high PSA score and even for those who are told they have a tumor.
Urologists and even general practitioners are reluctant to give up on the PSA test. They continue to use as if it means something. My guess is that most men middle-aged and up are still being regularly tested. “Do nothing” is not an appealing strategy to most people — and that includes patients, who are easily panicked into biopsies, and then into radiation or surgery, when a doctor starts throwing around the “C” word.
Lee Euler Publisher