Screening For Prostate Cancer May Do More Harm Than Good

Prevention task force says the screening leads to unneeded, harmful treatment

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The United States Prevention Task Force has caused another controversy by recommending against a test for cancer. This time, it's the PSA blood test, which screens for the possibility of prostate cancer. The wide use of the test has led thousands of men to undergo unnecessary and damaging treatment, the task force said in recommending that the test be discontinued.

The panel's announcement was greeted much as its call for an end to mammograms for women in their 40s was two years ago. Doctors, namely urologists, are outraged, and have begun a public relations campaign to reverse the recommendation.

The stakes of the disagreement are as high as it gets: the task force says the PSA test doesn't save lives. A doctor and defender of the test tells The New York Times that some men will die if the PSA is phased out.

If the panel’s analysis of the science is correct, thousands of men were probably harmed by unnecessary tests and treatments during the delay.

At the heart of its advice is the startling finding that thousands of doctors in the United States have been doing many of their patients more harm than good. While the panel did not explicitly level such a charge, Dr. LeFevre said that the dangers of common treatments were what drove the members to recommend against screening. “If you’re the guy doing the treatment, that’s pretty hard to swallow,” he said.

But use of the PSA test has coincided with a drop in the mortality rates for prostate cancer, notes David B. Samadi, a urologist and commentator for Fox News' "Medical A Team." The attempt to phase out the test risks making the perfect the enemy of the good, he contends.

PSA is not a perfect test. Prostate cancer can be an indolent cancer, taking many years to decades before it causes problems or it can behave in a highly aggressive manner. PSA is not able to differentiate these two cases. However, by tracking PSA velocity and density we can more accurately predict ones risk of cancer.

Survivors were taking the government decision to task, too, including the writer and journalism professor Jeff Jarvis, who said the panel was preventing patients from gaining basic information about their own bodies. "Wrong. Profoundly, fatally wrong," he wrote to followers on Google+.

One other group leapt to action at the task force's announcement: insurance companies. Some major insurers, including Aetna and Kaiser Permanente, are now reviewing whether they'll continue to pay for the PSA test, which costs less than $50, The Times reported.

This article is from the archive of our partner The Wire.