In May, the U.S. Preventive Services Task Force (USPSTF), the independent panel that sets U.S. cancer-screening policy, released their final PSA screening report. The task force’s findings: Men should not get regular PSA tests to screen for prostate cancer because more harm than benefit comes from the routine test.
“Many men will be harmed by prostate cancer screening. Very few will benefit,” said USPSTF co-chair Michael LeFevre, M.D. “The benefits do not outweigh the harms, and therefore we do not recommend screening.”
The USPSTF further concluded that for every 1,000 men who have a PSA test:
- One will avoid death from prostate cancer.
- One will develop a blood clot due to treatment.
- Two will have heart attacks due to treatment.
- Forty will be left impotent or unable to control urination due to treatment.
Urologists protested the USPSTF’s decision, especially for men at high risk of being diagnosed with prostate cancer. This is especially important for African-American men (and those with a family history of the disease), who are at greater risk of contracting and dying from the disease. The task force acknowledges the increased risk for these two groups of men, but concluded that the benefits and harms of PSA screening remain the same, no matter the race or family history.
PSA Test: What Should Men Do?
The American Cancer Society (ACS) recommends that men discuss the harms as well as the benefits with their physicians before scheduling a PSA test.
Many members of the American Urological Association (AUA) agree. They say men should talk with their doctors first.
“Americans have been taught for decades to fear all cancer and that the best way to deal with cancer is to find it early and treat it aggressively,” wrote Otis Brawley, M.D., chief science officer at the ACS, in an editorial accompanying the USPSTF’s recommendation. “As a result, many have a blind faith in early detection of cancer and subsequent aggressive medical intervention whenever cancer is found. There is little appreciation of the harms that screening and medical interventions can cause.”
But Dr. Brawley is clear to distinguish between PSA tests performed by a man’s personal physician after the implications of the screening have been discussed and the mass screenings conducted for free in malls and community centers.
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