> Men shouldn't be screened for prostate cancer with a common blood test, a
> widely followed federal advisory panel recommended on Monday. But the
> report isn't likely to quell a dispute about whether the test's risks
> outweigh its potential benefits.
> The U.S. Preventive Services Task Force recommended a "D" grade for
> prostate-specific-antigen, or PSA, testing which has been widely used for
> almost two decades to screen men for prostate cancer. Previously the task
> force had recommended against PSA testing for men age 75 and older. Now the
> recommendation extends to all ages.
> A "D" rating means "there is moderate or high certainty that the service
> has no net benefit or that the harms outweigh the benefits," the group's
> website says. It also is a recommendation "against the service."
> The Task Force report, published Monday online in Annals of Internal
> Medicine, said PSA screening detects many asymptomatic or slow-growing
> cases of cancer that won't cause men any problems in their lifetimes.
> Treatments for those cancers can include surgery and radiation and can
> cause side effects such as impotence or urinary incontinence.
> “The U.S. Preventive Services Task Force reviewed studies showing the test,
> widely used for almost 20 years, could lead to unnecessary cancer
> treatments.”
> The task force said it conducted a review of clinical studies of PSA
> testing, including a large U.S. study and a European one. The U.S. study
> didn't find a mortality benefit. The task force said the European study
> suggested a small benefit of no more than 1 in 1,000 men screened.
> "Many men are harmed by prostate-cancer screening" with a PSA test, said
> Michael LeFevre, the task force's co-chairman and a professor at the
> University of Missouri School of Medicine. "Very few will benefit." The
> task force is made up of 16 nonfederal, primary-care providers who review
> preventative health services and make recommendations, primarily for
> primary-care doctors.
> Dr. LeFevre said the task force recommended doctors could still offer the
> PSA test if men are informed about the risks and benefits of the test. The
> blood test is meant to detect a substance found normally in the prostate
> that is also made by cancer cells. Men with higher PSA scores typically
> have a higher risk of developing prostate cancer. But the test isn't
> perfect, and in some cases follow-up biopsies find no cancer.
> In October the task force released a draft recommendation against PSA
> testing and took public comments. Many doctors who treat prostate cancer
> worry that the final recommendation will simply keep primary-care doctors
> from discussing the issue with patients, even those with high risk for the
> disease such as African Americans or those with a family history. They
> argue the test can offer important information about which men are at risk
> for developing prostate cancer.
> "There's a huge difference between over-diagnosis and overtreatment," said
> Anthony D'Amico, chief of Genitourinary Radiation Oncology at Brigham and
> Women's Hospital and Dana-Farber Cancer Institute in Boston. Dr. D'Amico is
> co-author of a paper also to be published this week in the Annals of
> Internal Medicine arguing against the task force's recommendation.
> The American Urological Association recommends doctors and male patients
> discuss PSA testing, but discourages mass-screening events where the tests
> are offered free, such as at health fairs, says Ian Thompson, chairman of
> the group's prostate cancer guideline panel.
> "Men should be informed of the opportunity" to get the test, says Dr.
> Thompson, who is also chairman of the Cancer Therapy & Research Center at
> the University of Texas Health Science Center at San Antonio.
> The recommendations can influence coverage decisions by Medicare and other
> insurers, though under current law, Medicare must cover annual PSA testing.
> Prostate cancer is the most common non-skin cancer diagnosed in men. The
> American Cancer Society estimates that 241,740 men will be diagnosed with
> prostate cancer this year, with 28,170 expected to die from it.
> *Write to *Jennifer Corbett Dooren at
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