USPTF Recommends Against Screening Prostate Cancer with PSA
May 22nd, 2012The USPTF (United States Preventative Task Force) recommended against the use of PSA as a screening tool for prostate cancer today. PSA (Prostate Specific Antigen) is a protein that is found in the blood which can be elevated with prostate cancer, prostate infections, and enlargements of the prostate. The guideline, which can be accessed on the Annals of Internal Medicine site, carries the “D” designation which means the PSA screening causes more harm than good. This is already causing a flurry of controversy in the medical community and among prostate cancer survivors.
On one hand you have a disease that some experts consider an “inevitable” course of nature which all men will develop in older age. This type of cancer is usually slow growing but can cause some problems if it grows large enough to cause blockage of the urinary tract or severe pain if it spreads to the pelvis and spine. Opponents to PSA testing contend that too many people have been undergoing unnecessary biopsies and prostatectomy (surgery to remove the prostate) which can result in impotence and incontinence. Each surgery performed also carries signficant cardiac risk, especially for men in their 50’s for whom PSA screening was previously recommended.
PSA is still recommended for men who have had prostate cancer in the past to monitor for recurrence, and for men with symptoms of prostate problems (difficulty urinating, incomplete voiding of the bladder, etc.). When someone has symptoms, the test is no longer considered a “screening”. The USPTF should have also considered that we have a growing population of men who are taking testosterone replacement and a population that is more obese than ever, both factors that raise the risk prostate cancer.
While I can see the argument on both sides, I think the patient should have the right to make an informed decision. Most internal medicine associations have recommended that all doctors have a conversation with their patients laying out the risks and benefits of PSA screening with a digital rectal exam (DRE) and having the patient decide. I still believe this to be the most prudent practice. Unfortunately, with the statement made by the USPTF, insurance companies may start to deny payment for PSA testing. My recommendation is that if you are over 50, and have not had an annual physical, go see your physician and have a talk about cancer screening.
