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Panel’s Pitch to Nix Routine Prostate Cancer Tests Draws Strong Reaction

October 7, 2011 at 12:00 AM EDT
The U.S. Preventive Services Task Force said Friday that prostate specific antigen tests, known as PSAs, that are done to detect prostate cancer could be doing more harm than good. Jeffrey Brown discusses the latest controversial recommendation from the influential panel with The Washington Post's Rob Stein.

JEFFREY BROWN: Men shouldn’t be routinely tested for prostate cancer. That was the recommendation today of an influential government panel that looked at whether PSA tests can extend lives by detecting cancer earlier.

The tests measure levels of a protein made in the prostate. But the U.S. Preventive Services Task Force said they do more harm than good, including unnecessary biopsies, surgery, radiation and impotence. The panel concluded that — quote — “The common perception that early detection prolongs lives is not supported by the scientific evidence.”

Last year, more than 217,000 American men were diagnosed with prostate cancer; 32,000 died from it. And the recommendations are being met with both support and anger.

We look at all of this now with Rob Stein, who covers health and science for The Washington Post.

Rob, welcome.

So, they’re saying they can find no real benefit from these tests?

ROB STEIN, The Washington Post: That’s right.

Overall, when they have taken a hard look at the scientific evidence, what the panel is saying is they concluded that there’s no overall benefit compared to the risks that men face if they’re told to undergo routine PSA testing. These are — if healthy men are told go in and just get a PSA test on a regular basis to see if you have prostate cancer.

JEFFREY BROWN: And just to back up, that is the current standard practice now?

ROB STEIN: That’s right.

The way it works right now is once a guy hits about 50, his doctor usually starts recommending that he get a blood test, which is PSA test, to look for any signs that he might have prostate cancer. And then he pretty much gets it on a routine basis every time if he goes in for a routine physical or a routine checkup.

JEFFREY BROWN: All right, so fill in this picture about the risks, risks that outweigh any possible benefits. What are we talking about?

ROB STEIN: Yes. What they’re talking about is, when somebody comes back with a positive PSA test, something that indicates that he might have prostate cancer, it starts sort of a cascade of medical treatments that can lead to some pretty serious complications.

At first, you start off with a biopsy to see if the guy actually has prostate cancer, and that’s usually not that big a deal to go through and pretty safe. But in some cases, there can be complications and it can take some time to recover from even that. And then it turns out that — if he has prostate cancer, then he has to undergo surgery or radiation. And that can have some very serious complications, the biggest ones being impotence and incontinence.

JEFFREY BROWN: Now, it’s important to say that this panel — these recommendations are for men who do not have any symptoms, correct?

ROB STEIN: Right. And that is very important.

This is for men who basically are healthy, there’s no sign that they might have prostate cancer, there’s no reason to think that they might have a tumor that nobody has picked up yet. It they’re — for men who do have signs, for men who there are indications they have prostate cancer, they should be going in and getting tested.

But this is — this is for the general, sort of routine, “don’t even think about it” recommendation that you just go out and get a PSA test on a regular basis without even — maybe even knowing you had the test done.

JEFFREY BROWN: And when — one of the issues here I guess is that prostate cancer develops very slowly, right?

ROB STEIN: Yes. No, that is — that’s a very important point is that prostate cancer, it’s a very common cancer, but in a lot of men, they don’t even know they have it, and if they never were tested for it, they might never find out that they had it. It grows so slowly, that they would end up dying of something else.

And so that’s the big problem with prostate cancer, is right now we can’t identify which men need treatment and which men don’t. So if you go in, you get a test, you find out you have prostate cancer, pretty much most people are going to get treated. And that could lead to all sorts of complications that could even cause deaths, that could outweigh the benefits of the routine PSA testing.

JEFFREY BROWN: Now, everything here, all this, the PSA testing, has been debated for a long time. It’s been quite controversial. And now these new recommendations are extremely controversial, I gather.

Tell us about the reaction.

ROB STEIN: Yes. It’s been a very strong reaction to this.

You have to remember this is the same panel that in 2009 caused a firestorm when they raised questions about routine mammography for breast cancer for younger women. And we’re starting to see some of the same reactions to this. There’s a large cadre of doctors and patients and patient advocacy groups who think that PSA testing is extremely important and saving lots of lives, and anything that raises any questions about it is going to cost a lot of lives.

So people are very upset about this.

JEFFREY BROWN: Well, so how influential is a panel like this? What — where do you look at for impacts here for — among doctors, among insurance groups and so on?

ROB STEIN: This is a very influential panel. And that’s why people — the reaction is so strong.

You know, this panel can’t make anything happen, but doctors, you know, look to this panel to, you know, decide what advice to give their patients. Insurance companies look at what the panel recommends to decide what they should pay for. And, in fact, under the health care, the federal health care reform legislation that passed, this panel has actually become more influential, because some of the basic benefits that the federal government will require under the health reform legislation will be influenced by this panel’s recommendations.

JEFFREY BROWN: So, briefly, Rob, what happens next? Is this a period of confusion for the medical community and men in general? Or what are you looking at?

ROB STEIN: Yes, it’s important to note that, at this point, this is a proposal. So the panel is proposing changing its recommendations. They’re proposing downgrading their recommendation for PSA testing to recommend not getting routine testing.

It will be open now for a period of time for public comment. This is one of the changes that the panel implemented after the uproar over the mammography recommendations, so the public has a chance to say what they think about it, and the panel will take a look at those comments and decide what to do for their final recommendations.

JEFFREY BROWN: All right, Rob Stein of The Washington Post, thanks so much.

ROB STEIN: Oh, thanks for being — nice being here.