Taking the PSA: Pros and Cons of Testing for Prostate Cancer
At first glance, deciding whether to get the PSA screening test for prostate cancer seems pretty straightforward.
It's a simple blood test, and it can pick up prostate cancer long before symptoms appear. After all, the earlier cancer is treated, the better, right?
But studies have failed to find a lifesaving benefit of the PSA (prostate-specific antigen) screening. Many of the cancers it detects are so slow-growing that they might never have caused problems. And their diagnosis via biopsy, and treatment, can be worse than the disease itself.
For those reasons, the U.S. Preventive Services Task Force, a panel of experts sponsored by the Agency for Healthcare Quality and Research, is recommending against PSAs in men without "highly suspicious" symptoms. (Its previous advice, in 2008, recommended against the PSA only for men 75 and older; most doctors agree that older men with undiagnosed prostate cancer are likely to die of something else.)
The task force on Tuesday will begin accepting comments on its new draft recommendation. Already, critics have fired off angry tweets and blog posts about loved ones or patients being saved by a PSA test. However, even advocates say the test is far from perfect.
"I'm not saying that everybody should be screened, and there are real problems with PSA as a tool to find prostate cancer," says Benjamin Davies, assistant professor of urology at the University of Pittsburgh. "But it does a disservice to Americans saying no one should be screened."
Men rarely say they don't want a PSA, says urologist Elizabeth Kavaler of Lenox Hill Hospital in New York City.
"The problem is that we wind up picking up a lot more cancer than we actually need to know about," she says. What's needed, she adds, is a test to distinguish the relatively harmless cancers from the bad ones.
For tiny, non-aggressive tumors, doctors increasingly advise "active surveillance," giving patients periodic biopsies instead of treatment.
But some men "can't handle living with cancer," says urologist Mayer Grob of Virginia Commonwealth University. "They want it out."
And 20% to 30% of men who get surgery or radiation have adverse effects, including urinary incontinence and erectile dysfunction, doctors say.
"The quality of life is less than that for patients who never got treatment," says Harvard prostate cancer specialist Marc Garnick. Even biopsies can cause serious complications, he adds. He agrees with the advice against PSAs for everyone but says "not one size fits all. It's very difficult to say to a patient whose father, whose uncle died of prostate cancer, 'We're not going to do a PSA test on you.'" Still, "they have to know what the pros and cons are."
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