Routine prostate cancer screening should be halted for most men, according to a new recommendation by the United States Preventive Services Task Force (USPSTF), a key government advisory panel.
The independent experts on the task force concluded that PSA screenings lead to over-diagnosis of prostate cancer, unnecessary surgery, and unwelcome long term side effects and psychological harms such as impotence and incontinence.
The new recommendations appear in the May 22 issue of Annals of Internal Medicine.
According to USPSTF co-chair Michael LeFerve, M.D., there is a very small potential benefit and significant potential harms. We encourage clinicians to consider this evidence and not screen their patients with a PSA test unless the individual being screened understands what is known about PSA screening and makes the personal decision that even a small possibility of benefit outweighs the known risk of harms.
Based on available evidence, the task force concluded that better tests and treatments need to be developed. Until then, they say most PSA screenings should be stopped. This simple blood test measures the level of prostate-specific antigens - a protein - produced by the cells of the prostate gland.
Reuters News reported that reaction to the new recommendation was swift. Those in favor of continuing screenings believe the new guidelines will lead to additional deaths; supporters of the task force report echoed the need to eliminate unnecessary cancer treatment.
Otis Brawley, M.D., chief medical officer and vice-president of the American Cancer Society, wrote in an accompanying editorial: "Potential harms of PSA screening are well-documented, but questions surround the potential benefits..." and asks whether the benefits outweigh the harms. He agreed with the task force's recommendations.
However in the same issue of the journal, critics of these changes in PSA testing reminded readers that prostate cancer is the second leading cause of death in men in the U.S. and that no urologists or cancer specialists sat on the panel that made the recommendations.
The ad hoc group of nationally recognized prostate cancer experts, preventive medicine specialists, and primary care physicians, "believe that the USPSTF has underestimated the benefits and overestimated the harms of prostate cancer screening." The National Cancer Institute (NCI) estimates that 28,000 men will die of prostate cancer in 2012.
The USPSTF made similar controversial news in 2009 when it issued hotly contested guidelines for breast cancer screening to begin at age 50 for most women – contradicting recommendations by the American Cancer Society and other leading cancer organizations that women start screening mammography at age 40.
A Boston Globe article observed that the American Cancer Society had no plans to change its current prostate cancer screening recommendations, despite Dr. Brawley's support for the new guidelines. They advise men to discuss the screening's benefits and risks with their physicians before deciding whether it is right for them.