Key panel will urge men to skip prostate screening, reports say
The U.S. Preventive Services Task Force is set to recommend that middle-aged men skip routine screening for prostate cancer, according to reports circulating Thursday.
The task force, which sets disease prevention policies for the federal government, is scheduled to issue its new recommendations Tuesday, according to the Santa Monica-based Prostate Cancer Foundation. But the New York Times and a weekly newsletter known as the Cancer Letter reported Thursday that the task force would change its position on the widely used PSA test to recommend that men under age 75 forgo it.
The chairwoman of the task force, Dr. Virginia Moyer of Baylor College of Medicine in Houston, could not be reached for comment Thursday.
Such a change would be controversial. Although a series of clinical studies has raised questions about the benefits of the test, many doctors maintain that it is valuable.
“That would be a very big surprise for the urology community,” said Dr. Milton Krisiloff, a urologist at St. John’s Health Center in Santa Monica. “Prostate cancer kills a lot of people. It’s not an innocuous disease. If they say just eliminate PSA, then a lot of people are going to die.”
Many doctors and patients had the same complaint in 2009, when the task force softened its endorsement of mammography as a screening tool for breast cancer. The panel said that routine testing for women of average risk should begin at age 50 instead of 40 and that mammograms should be done only once every two years. Those recommendations have largely been ignored.
The PSA test for prostate cancer looks for prostate-specific antigen, a protein produced in the prostate that helps make semen. A small amount of PSA typically circulates in the blood of healthy men. Levels above 4 nanograms per milliliter of blood could indicate the presence of prostate cancer.
The problem with the test, critics say, is that it flags too many patients for follow-up procedures that can be expensive and sometimes risky. Among men with results in the range of 4 to 10 ng/ml, biopsies show that 70% will have false-positive results and 30% will have prostate cancer. In addition, the disease is frequently slow-growing and causes no harm if left unchecked.
About 20 million American men have a PSA test each year. The National Cancer Institute says that 240,000 men are diagnosed with prostate cancer in the U.S. each year, and 33,720 die.
In 2008, the task force said that men over the age of 75 should stop getting routine PSA tests. But it added that there was “insufficient evidence” to recommend PSA screening for men younger than 75.
The American Cancer Society reviewed the evidence in 2009 and said that it remained unclear whether PSA screening saved lives. The society recommends men of average risk talk to their doctors about screening beginning at age 50 and that higher-risk men discuss screening at 45.
The American Urological Assn. currently recommends that men over 40 talk to their doctors about PSA screening.
Studies have shown that PSA screening detects more prostate cancers but does not lower death rates from the disease. Though some cases of prostate cancer are aggressive, others are so slow-growing that treatment is unnecessary.
Only a biopsy can confirm the presence of cancer. A European study published in the New England Journal of Medicine in 2009 found that about 1,400 men would need to be screened and 48 treated to prevent one death from the disease.
A bigger issue than the PSA test is how men are treated for prostate cancer, said Dr. Karim Chamie, a urologist at UCLA’s Jonsson Comprehensive Cancer Center.
“What we do with the information is where the problem lies,” he said. “Knowing and making an informed decision is a patient’s right.”
Chamie said that physicians were studying new technologies to help minimize the number of false results and that giving up on the PSA at this point “is kind of like us giving up on flight after the first few Wright brothers crashes.”
It’s not clear whether the task force’s report will include a blanket recommendation against the PSA test or whether it will be more nuanced, said Dan Zenka, senior vice president of communications for the Prostate Cancer Foundation, which pushes for and funds research.
“We’re looking forward to seeing the complete report on Tuesday so we can review it in depth,” he said. “Right now it would be premature to speculate.”
But, Zenka said, “there is still a great deal of confusion around it because PSA is not a cancer test. It is one step in the diagnostic process. Men need to talk to a physician who understands what the PSA test is and isn’t. There is no one-size-fits-all.”
The American Cancer Society also declined to comment, citing the need to see the report next week. But in a statement, Dr. Otis W. Brawley, chief medical officer of the society, said: “It is important to keep in mind that under the new USPSTF [U.S. Preventive Services Task Force] process, the recommendation is not final until the conclusion of the public comment period and the USPSTF’s review of those comments.”
Health insurance companies and Medicare administrators usually follow the task force’s recommendations in deciding which medical tests to cover.
