Tuesday, May 22, 2012

PSA Tests Not Advised

A top panel of health experts, the US Preventive Services Task Force (USPSTF) has issued their ruling that prostate specific antigen (PSA) tests should not be done as a screening test on any man.  This is after several years of controversy about the blood test that many men get routinely at their annual physical exam.  The task force said the test leads to treatments that do more harm than good...in medical terms we say the risks outweigh the benefits.

This ruling sparked an outcry from the American Urologic Association, who said the recommendation was "inappropriate and irresponsible".  Keep in mind that the urologists are the specialty that benefits from biopsies and other imaging tests that are needed to confirm whether a PSA is a "true positive" or a ""false positive".  The Association recommends annual PSA tests for men over the age of 40.

The American Cancer Society's chief medical officer, Dr. Otis Brawley, said he agreed with the Task Force recommendations.  We can expect there to be continued controversy about PSA screening now that this ruling has been issued as the various specialties issue their own response.

Like many tests, the PSA has such a high false positive rate, it has proven to be a poor screening test for healthy men.   Unfortunately, like the Ca-125 test  for ovarian cancer, there is not a good alternative screening test.

 It should be noted that there is a difference between a screening test that is done routinely on healthy patients and a diagnostic test that is performed on high-risk people or to follow known disease.  African American men have a much higher rate of aggressive prostate cancer and men in high risk groups may get higher benefit from these tests.

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.

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