Panel Withdraws Support of Prostate Cancer Test
< May. 23, 2012 > -- A blood test that screens for prostate cancer got the cold shoulder this week from a national advisory panel.
The U.S. Preventive Services Task Force says that men should no longer be screened with the test because it leads to unnecessary treatment that can leave men incontinent or with erectile dysfunction (ED).
The prostate-specific antigen (PSA) test measures the amount of PSA in a man's blood. PSA is a protein made by the prostate that shows up in the blood when cancer begins to form. Many cases of prostate cancer are not life threatening because they grow so slowly, but the test can't tell whether a cancer is slow-growing or aggressive.
"PSA diagnoses every cancer that walks, and not every prostate cancer that walks needs to be cured," says Anthony D'Amico, M.D., at Brigham and Women's Hospital in Boston.
This year, 241,740 new cases of prostate cancer will be diagnosed in the U.S., and 28,170 men will die from it. More than two-thirds of those deaths will occur in men who are older than 75, the task force says.
African-American men and men with a family history of prostate cancer are at higher risk of developing the disease, the American Cancer Society (ACS) says.
Until now, the PSA test had been recommended for men beginning at age 50. But based on the results of two major trials of the PSA test in U.S. and European men who had no symptoms, the task force concluded that the screening may help save the life of only one man in every 1,000. Yet up to five men in 1,000 will die within a month of prostate cancer surgery, and 10 to 70 men in 1,000 will have lifelong side effects, including urinary incontinence, ED, and bowel dysfunction.
Some experts criticized the task force's recommendation because no one on the panel is a urologist or an oncologist, the specialists who diagnose and treat prostate cancer.
"There's just no other way to detect prostate cancer early than through PSA testing," says William Catalona, M.D., at Northwestern University in Chicago. "If we were to completely stop PSA testing in all men . . . it would result in countless men dying of metastatic prostate cancer."
ACS chief medical officer Otis Brawley, M.D., encourages men to talk with their doctor and make their own choice about PSA screening. But he also says that the task force's decision will allow better screening tests to be developed.
"Truth be told, prostate cancer screening as a whole, and its progress, has been delayed because so many people have been adamant about doing PSA screening in the last 20 years and not assessing if it works," Dr. Brawley says.
The task force's recommendations were published online this week in the Annals of Internal Medicine.
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Your Risk for Prostate Cancer
Some factors put you at high risk for prostate cancer. If you agree with either of these statements, you're at high risk, according to the American Cancer Society:
I'm African-American. African-American men are at higher risk for prostate cancer than white men. You're especially at risk if your relatives are from sub-Saharan Africa.
My father, brother, or son had prostate cancer. These men are considered your first-degree relatives. The fact that they've had prostate cancer makes your risk higher. In some families, certain genetic mutations may increase the risk for prostate cancer.
Other factors increase your risk for prostate cancer. Some are out of your control, such as your age or family history. But some risk factors - such as the types of food you eat - are factors you can control.
If you agree with either of the statements below, you may be at increased risk for prostate cancer:
I am 55 or older. The older you get, the higher your risk for prostate cancer. More than 90 percent of diagnoses are made in men ages 55 and older. The average age of diagnosis is 67.
I eat a lot of red meat or dairy products. Men who eat a lot of red meat or high-fat dairy products appear to have a slightly higher chance of getting prostate cancer. These men also tend to eat fewer fruits and vegetables. It's not clear which of these factors might be responsible for raising the risk.
Always talk with your health care provider to find out more information.
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Annals of Internal Medicine - Screening for Prostate Cancer
National Cancer Institute - Prostate Changes: A Health Guide for Men
National Institute on Aging - Prostate Problems