Experts recommend against prostate cancer screening

An independent expert panel is recommending that U.S. doctors not use a special blood test to detect prostate cancer. The congressionally appointed advisory group says the widely used test does more harm than good.

Prostate cancer is the second most common cancer diagnosed in American men. Last year, 240,000 people got the bad news, mostly older men over 60. The disease was fatal for 33,000 people.

The prostate or prostate gland is a small organ that resembles a walnut. It is part of the male reproductive system and produces the fluid that is part of sperm.

Since the 1990s, prostate-specific antigen (PSA) testing has become a routine medical procedure for men over 55 in the United States and some other developed countries. The test measures a protein in the blood that increases in the presence of prostate cancer cells. If cancer is detected, the patient undergoes intensive treatment to shrink the tumor, which may include radiation therapy, surgery, or estrogen.

However, PSA tests often give false alarms, and men who later find out they don't have cancer or whose tumors are so small that they pose no real threat to their health are forced to undergo unnecessary and potentially dangerous procedures such as prostate tissue biopsies.

In 2008, an expert committee recommended against PSA testing for men over 75. Now, experts say the tests are unnecessary. The committee came to this conclusion based on two large studies that aimed to assess the benefits of such tests.

Based on the results of clinical trials conducted in the United States and Europe, experts have concluded that the risks of prostate screening significantly outweigh the benefits.

"In the best-case scenario, only one in a thousand people who undergo this procedure will avoid dying of prostate cancer in the next ten years," explains Virginia Moyer, chair of the panel. "In the meantime, two or three people will suffer complications such as a blood clot, heart attack, or stroke. And forty people will suffer serious consequences from the procedure: erectile dysfunction, urinary incontinence, or both."

In addition, five out of these thousand will die within a month of undergoing surgery to treat prostate cancer.

But not everyone agrees with the experts' recommendations. Critics say the studies on which they are based are seriously flawed. In particular, they say, faulty methodology casts doubt on the conclusion of a U.S. study of 76,000 men that prostate cancer death rates were no different between men who had the procedure and those who did not.

The commission also relied on a study in seven European countries that concluded that the PSA test saves at most a few lives. But critics say that if flaws in the study's methodology are corrected, the test could cut the risk of dying from prostate cancer by a third.

Dr. William Catalona, a professor of urology at Northwestern University School of Medicine in Illinois and director of the department's prostate cancer research program, said the panel's recommendations border on irresponsible.

"This is a completely ill-advised, baseless and unsubstantiated move," he says. "This is very bad advice."

Catalona says the PSA test identifies 10 to 15 percent of men who are at risk for prostate cancer. Many men with elevated PSA levels undergo a biopsy. Catalona compares it to the use of Novocain in dentistry to relieve pain.

"Yes, it will be uncomfortable. It will hurt a little bit for a while, but it will go away in a few days," he says. "And you'll be glad you did, because if you hadn't done it and an abscess had developed, it would have been much worse."

Commission chair Virginia Moyer says experts are not recommending that PSA testing be abandoned entirely, but that there is no need for widespread screening.

"If a person insists on doing research and understands its potential benefits and possible harm, then why should they be prohibited from doing it? It's their individual choice," she says.

Doctors are not required to follow the panel's recommendations, but they may be heeded by insurance companies, which may refuse to cover PSA testing. The panel's recommendations and a critical commentary by Dr. William Catalona are published in the journal Annals of Internal Medicine.

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