In a recommendation certain to be both ignored and widely criticized, government health advisers said most men should not get a common blood test for prostate cancer, saying it often caused more harm than good.
But the U.S. Preventive Services Task Force also notes that many men really would prefer to be screened, so it says each man should decide individually with his doctor whether to get the test, which check for levels of a protein called prostate specific antigen. PSA rises when the prostate grows but this growth could come from cancer or from harmless conditions – and even when men have prostate cancer it’s often so slow-growing that it is unlikely to kill them before something else does.
“It’s important for doctors and patients to understand that our current approach to screening for prostate cancer does not serve men well,” said Dr. Virginia Moyer, who chairs the task force.”There is a critical need for a better test—one that leads to early detection of cancers that threaten men’s health, but minimizes unnecessary, risky tests and treatments that do not lead to longer or more healthful lives.”
The report, published in the Annals of Internal Medicine, points to all the side-effects that come from treating prostate cancer with surgery, radiation or drugs. For every 1,000 men who get a PSA test, one develops a blood clot in his legs or lungs due to treatment; two have heart attacks due to treatment; and up to 40 are made impotent or incontinent.
“At best, PSA screening may help only 1 man in 1,000 avoid death from prostate cancer,” the USPSTF said in a statement.
“Most prostate cancers found by PSA screening are slow-growing, not life threatening, and will not cause a man any harm during his lifetime. However, there is currently no way to determine which cancers are likely to threaten a man’s health and which will not. As a result, almost all men with PSA-detected prostate cancer opt to receive treatment.”
The group is used to causing controversy.
In 2009, the panel caused a furor when it recommended that women get mammograms every other year, starting at age 50. Most groups advise women to start at 40 and to get mammograms every year. Health and Human Services Secretary Kathleen Sebelius immediately rejected it.
And when the draft prostate recommendations were released in December, several lawmakers rebelled.
"Until we have a better test and better treatment options, based on a comprehensive review of the science, the USPSTF recommends that men not get the PSA test to screen for prostate cancer," the panel said.
"You should know what the science says about PSA screening: There is a small potential benefit and there are significant potential harms. But you should also think about your personal beliefs and preferences for health care. Weigh the potential benefits and harms of PSA screening and decide what is most important to you. If the possibility, however small, of avoiding death from prostate cancer is more important to you than the risk of unnecessary harms, then screening may be the right decision."