PSA Tests: What the Debate Means for Men

Oct 11, 2011 by Dr. Brandon Hayes-Lattin, MD

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PSA TESTS – Why Everyone’s Talking About Them and What the Debate Means for Men by LIVESTRONG Sr. Medical Advisor, Dr. Brandon Hayes-Lattin

This week the US Preventive Services Task Force issued a recommendation on prostate cancer testing that is attracting a lot of attention. For anyone wondering what this means, we’d like to shed some light and make a few suggestions.

Who is the US Preventive Services Task Force?

The Task Force “…is an independent panel of non-Federal experts in prevention and evidence-based medicine and is composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists). The USPSTF conducts scientific evidence reviews of a broad range of clinical preventive health care services (such as screening, counseling, and preventive medications) and develops recommendations for primary care clinicians and health systems.”

In practical terms, the Task Force is responsible for independently and objectively reviewing evidence to make preventive services recommendations to the nation’s physicians and health care providers. The special expertise of members of the Task Force is how to review medical evidence and apply medical tests for screening. This expertise is a different set of skills from that of actually treating a patient who has that disease, and so specialists (like urologists in this case) may find themselves coming to different conclusions. Members of the Task Force are able to look at these tough questions, like whether or not men should receive PSA testing, without having the same degree of bias: they are not in a position to profit from these tests or to have seen so many unusual or outlier cases that their memories cloud their objective judgment.

Task Force announcements can sometimes spark controversy. In 2009, the task force issued a recommendation that women over 50 should have annual mammograms. This was a big departure from the previous norm which included women 40 and older. The change sparked a national debate among health care providers, breast cancer survivors and policy makers which continues today.

What is the PSA Test and Why is the USPSTF Recommending Against It?

The prostate-specific antigen test is a blood test routinely taken by men to determine the presence of cells that indicate a high likelihood of prostate cancer. Since 1986, when the US Food and Drug Administration approved its use, it has become a routine and widely-used component of medical care for men middle-aged and older.

The USPSTF is now recommending the blood test no longer be used for the following reasons:

1. The Task Force can’t find convincing evidence that treatment for prostate cancer that was detected by this test leads to more lives saved or to an overall improvement in men’s health.
2. In many cases, prostate cancer may be present but is so slow-growing, it will never display symptoms or affect health or function.
3. Also, in many cases, treating the disease can be worse than the disease itself, and can lead to side-effects like urinary incontinence, impotence, and even death.

Why is This Attracting So Much Attention?

This new recommendation puts men in a tough spot. On the one hand, we’ve been told for decades to take a proactive approach to our health, to get as much information as we can and to be aware of the risks. Knowledge is power, right? Now the public is being steered in a different direction. We’re being told we may be better off not knowing if we have prostate cancer. The new guidelines say the treatment can be worse than the disease and that the test doesn’t save lives. In fact, it may lead to needless suffering, both physical and mental.

This latest advice comes on the heels of a 2008 recommendation against use of the test for men 75 and older. While it is true that prostate cancer is the most common cause of cancer deaths in this age group, it was found that the PSA test is just not good enough to actually save more lives, and that men who tested positive would most often suffer side effects without benefit.

What Should Men Do?

This is the most important question, of course.

When looking at the entire male population from a statistical perspective, one can see the logic of the Task Force recommendation. If the test doesn’t save lives and may even lead to unnecessary treatment and suffering, throw it out, right?

But what about those of us who believe that our lives have been saved as a result of the test? It’s true that for some men, the PSA test detected an aggressive and fast-moving cancer that could have claimed their lives. For them, the test was a life-saver.

The troubling question is, how do we know which category we fall into and how do we best prepare ourselves to make crucial decisions about our health? It’s an incredibly tough issue.

The Task Force did not evaluate the PSA test for men who have “highly suspicious symptoms.” So here’s what LIVESTRONG recommends:

• Men who have symptoms including trouble urinating or pelvic discomfort or who have a father or brother diagnosed with prostate cancer younger than age 60 should report this to their doctors to discuss their risk and their testing options.
• If you have any concerns, talk to your doctor. If that doesn’t help, get a second opinion or even a third. You deserve to know the facts that will allow you to make the best decisions about your health.

What Does This Mean for the Fight Against Cancer?

One thing’s certain: We are seeing again that many of the current tests we have for cancer are just not up to the task. Whether it’s PSA testing this year, or mammography recommendations in 2009, it is clear that we must invest more time and money into developing better tests. What we need are tests that don’t just screen for abnormalities but can detect which abnormalities will lead to serious cancer problems if left untreated.

It’s also clear that you have primary responsibility for your health. Know your risks. Talk to your physician. This can be tough, as many of us know. Doctors’ offices are busy places and sometimes getting in just for a consultation can take a while. However, don’t let that discourage you. Get a second opinion, even a third, if necessary. Ultimately, every medical decision is personal.