Johns Hopkins Health Alert
Should You Have a PSA Screening Test? Johns Hopkins Responds to Recent USPSTF Recommendations
By now, you’ve probably heard that prostate-specific antigen (PSA) screening is no longer recommended for healthy men under age 75. This controversial draft recommendation was issued by the United States Preventive Services Task Force (USPSTF). Given previous recommendations from the medical community encouraging PSA screening, many men are confused. Following are answers to some questions you may have about this recommendation -- and our advice on whether you should follow it.
What is the USPSTF? The USPSTF is an independent group of 16 medical experts whose recommendations serve as guidelines for doctors throughout the country. In addition, the group’s recommendations ultimately impact what tests Medicare and private insurers will pay for.
Why did they make this recommendation? According to the USPSTF, the potential harms caused by prostate-specific antigen (PSA) screening of healthy men as a means of identifying prostate cancer far outweigh its potential to save lives. The group discourages the use of any screening test for which the benefits do not outweigh the harms to the target population.
What are the potential harms of PSA screening? An elevated PSA reading can lead to an unnecessaryprostate biopsy. Although biopsies often reveal signs of cancer, depending on a man’s age, 30 to 50 percent will not be harmful -- even if left untreated.
After a positive biopsy comes the decision about what to do. Most men choose radical prostatectomy, external-beam radiation therapy or brachytherapy. But each of these treatments has the potential to cause serious problems like erectile dysfunction, urinary incontinence or bowel damage. And men who choose active surveillance must live with the uncertainty of knowing that they have an untreated cancer that could start to progress at any time.
Why does the Task Force believe PSA screening does not save lives? The USPSTF evaluated data from five large randomized clinical trials of PSA testing, including the Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) Trial, which reported no mortality benefit among 77,000 men who underwent PSA testing and were followed for t10 years.
Do these recommendations apply to all men? These recommendations apply to all men regardless of age, race or family history as long as they do not have symptoms of prostate cancer.
Our advice. Many leading cancer and patient groups and doctors agree that there is harm with PSA screening and the treatment that follows diagnosis. But a more targeted screening approach focusing on those at greatest risk of developing prostate cancer, and active surveillance for those who don’t need immediate treatment, could shift the balance of benefit and harm toward benefit.
PSA screening is the best test available for the detection of cancer cells in the prostate. Rather than discontinuing use of the only test available to detect the disease early and treat it successfully, efforts should focus on reducing harm.
Therefore, every man should discuss the benefits and risks of PSA screening with his physician. If you choose to be screened and the result is positive, you and your doctor should discuss whether any further intervention is appropriate or necessary.
Posted in Prostate Disorders on November 1, 2011
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