Image: Unfortunately, screening for prostate cancer isn’t as easy as you’d think. | Shutterstock
While it should be simple for people to know when and how to get tested for various conditions like breast cancer and prostate cancer, unfortunately that isn’t always the case. The official recommendations for testing male patients for prostate cancer are somewhat controversial. The topic pits some medical health professionals against each other, and patients should understand why the controversy exists and what it means for their health.
There is a test to screen for prostate cancer early on: the PSA test, which looks at levels of PSA, or prostate specific antigen, in the blood. Elevated levels of PSA are often, but not always, indicative of prostate cancer. The test does require that a blood sample be taken from the patient. However, in 2012, the US Preventive Services Task Force (USPSTF) recommended against using the PSA test because of potential complications associated with the biopsy and related treatment that are involved.
The panel felt that though such complications arose only in 10% of men screened via the PSA test, the risks were not balanced with the gain of averting one death per one thousand men over a 10-year period.
“Unfortunately, the PSA test is simply not an effective screening tool,” said Neil Bell, MD. “Almost 20% of men aged 55 to 69 have at least one false positive, approximately 17% will have unnecessary biopsies, and over half of the detected cancers are over-diagnosed, which is the detection of cancers that would not have caused symptoms or death during the lifetime of the patient.”
The USPSTF’s recommendation against using the PSA test was not well received by everyone. Many felt that the USPSTF “made its prostate cancer testing recommendations without input or perspective from the urology community or any other cancer care experts,” according to David F. Penson, MD, MPH. Penson also said that “men newly diagnosed with prostate cancer are presenting with higher PSA levels since 2011, perhaps due to decreased screening earlier in the disease course in response to the USPSTF recommendation.”
But men still need to be screened for prostate cancer, somehow. The Large Urology Group Practice Association (LUGPA) warned that reducing prostate cancer screenings would harm the public, a fear that they say has been confirmed by findings from the National Oncology Data Alliance.
LUGPA, a professional organization that represents over 20 percent of the nation’s practicing urologists, and others in the community strongly oppose the USPSTF’s recommendation that the PSA test not be used. LUGPA has joined others in an effort led by Reps. Blackburn and Bush that would prevent Medicare from denying coverage for services based on the USPSTF recommendation.
Luckily, if the PSA test can’t be used or won’t be administered, there are other tests that can and should be used for men between the ages of 55 and 70. The American Urological Association guidelines, published last year, advise men in this age range to discuss screening options with their doctors. Depending on the patient situation, the PSA test might still be the best bet. In the end, men need to talk to their doctors about what’s best for them.
Obviously, it’s not good to live in fear of cancer. But aside from non-melanoma skin cancer, prostate cancer is the number one most common cancer among men in the United States, regardless of race. According to the CDC, 177,489 men in the US were diagnosed with prostate cancer in 2012, and 27,244 went on to die because of it.
If you or someone you love has a prostate and is of a certain age, get screened regularly. Forewarned is forearmed!