Urologists Condemn Task Forces Anti-PSA Testing Stance

The U.S. Preventive Services Task Force (USPSTF) on May 21 released its final recommendations on PSA-based screening forprostate cancer (PCa), which advises against the practice and gives it a grade D rating, meaning the task force believes there is “moderate or high certainty that the service has no net benefit or that the harms outweigh the benefit.”

Since the introduction of PSA screening in the United States, the PCa death rate has decreased by more than 40% and the percentage of men who have distant metastases and incurable disease at the time of diagnosis has decreased by 75%. In addition, he noted that statistical teams at the National Institute of Health concluded that up to 70% of these results are attributable directly to PSA testing.“We think that men should be made aware and offered an opportunity to make an informed decision for themselves,” Dr. Catalona said. “The PSA test provides very powerful predictive information about a mans risk for prostate cancer.”

via Urologists Condemn Task Forces Anti-PSA Testing Stance – Renal and Urology News.

The government has recently issued a recommendation against prostate cancer screening.   The panel that issues this recommendation did not have a single urologist, radiation oncologist, or medical oncologist on the panel.

I agree with some of the conclusions of the task force that men often undergo negative prostate biopsies, which have a risk of infection and bleeding and are uncomfortable.  Negative biopsies cause anxiety without a cancer diagnosis.  It is also true that men are sometimes treated for cancers that may never cause them symptoms.

The benefits of screening were not given significant consideration.  Prostate cancer still kills men and screening does save lives.  Metastatic prostate cancer causes significant pain and its treatment, hormonal therapy causes long term side effects such as osteoporosis and decreases quality of life.

The other change has been the decreasing morbidity to treat prostate cancer.  Most men that have early stage prostate cancer are cured with surgery, but most of them have full return of urinary function.  The advantage of having surgery are a decrease in long term BPH (benign prostate growth) symptoms.  As men get older, they have increasing frequency, nocturia (urinating at night), slowing stream, and a hesitancy (difficulty in starting to urinate).  After surgery, men have a strong stream that does not change as they age.  The morbidity that panel looked at from treatment was worse than patients would face today.

 

PSA screening lowers risk of finding advanced prostate cancer


UroToday – European Urology – Prostate Cancer Screening Decreases the
Absolute Risk of Being Diagnosed with Advanced Prostate Cancer—Results from a
Prospective, Population-Based Randomized Controlled Trial

Conclusions: Even
though the reduction in metastasis at the time of diagnosis seen in the
present study is a prerequisite for a successful prostate cancer-screening
program, the ultimate outcome in the screening studies is a difference in
prostate cancer mortality. As the very large combined screening efforts (ERSPC
and PLCO trials) are to be analyzed regarding survival in 2008, we
strongly suggest that decisions regarding large-scale screening efforts
are deferred pending these reports.

This was already a well accepted position. I agree that the important thing will be to see if it can be proven to lower mortality.

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