Men are left to wonder as PSA test is disputed
By Deborah Kotz and Carolyn Y. Johnson
Globe Staff / October 8, 2011
New recommendations against using the PSA test to screen healthy men for prostate cancer could lead to a dramatic drop in use of the test now routinely given to about 75 percent of men over 50, but only if doctors follow through and change what they say to patients.
An independent panel of specialists concluded in draft recommendations posted online that the harms from screening outweigh the benefits for healthy men, and some Boston primary care physicians interviewed yesterday said they routinely listen to the US Preventive Services Task Force’s advice and will urge patients not to have the blood test to measure prostate-specific antigen, or PSA.
But leading area cancer experts said not so fast. They point to recent research, which they say showed a drop in prostate cancer deaths among some groups of men who were regularly screened.
The disagreement makes clear that ultimately men have to make their own choice.
“I’m very confident that different men will make different decisions; I’m reluctant to say one size fits all here,’’ said Dr. Michael Barry, medical director of the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital.
Barry said he discusses the pros and cons of PSA testing with his male patients. “What I think is very important is that men aren’t oversold on the benefits of this test,’’ he said.
The recommendations are based on a scientific review of more than 30 studies showing that screening for prostate-specific antigen results in little or no reduction in cancer deaths and may result in harm such as incontinence and impotence from overtreatment of slow-growing cancers that never would have become life threatening.
The influential task force, which evaluates a broad range of preventive services and issues periodic statements on their merits, downgraded PSA screening from a grade of I for inconclusive to D, for no benefit for men under age 75. The guidelines could be tweaked after a one-month public comment period.
Primary care physicians are the ones who typically offer PSA testing to patients, and at Boston Medical Center, Dr. Jonathan Berz said he will probably change the advice he gives patients, no longer simply laying out the risks and benefits. “Now I may feel justified in saying it’s not a good test for them,’’ he said, adding that he is going to direct the residents he trains to do the same.
Elevated readings on the test may signal the presence of cancer, but there is no agreement on what level indicates a tumor. Studies show 13 percent of men who have regular PSA screenings wind up with at least one false PSA finding for every four screenings they have, while nearly 6 percent undergo a biopsy for this false reading. These biopsies can lead to infections, bleeding, and urinary problems.
Full story: http://www.boston.com/news/local/massachusetts/articles/2011/10/08/new_psa_testing_guidelines_prompt_debate_among_doctors/
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