PSA Screening Faceoffs
Continuing with the ongoing controversy regarding PSA screening indicate that based on US Preventive Services Task Force recommendations, the PSA screening would be downgraded from an ‘I’ as in inconclusive to a ‘D – no benefit’ as in don’t. Well, reactions are pouring in from everywhere and they are a mixed lot too. While there are patients who claim to have been saved due to a routine PSA screening, there are the significant others who wished they had never known about the tumor in their prostate.
Medical practitioners and health care providers are concerned since the recommendations can stigmatize men into avoiding the simple PSA blood test completely. However, the USPSTF’s recommendations might initiate a more complete discussion between patients and doctors regarding the real pros and cons of the screening and prostate cancer.
So What Exactly is the USPSTF Saying?
As reported in The New York Times, the task force recommends against prostate cancer screening. The recommendations discourage PSA screening of healthy men since the test has no net benefit or may cause more harm than good. The task force bases their conclusions on 5 trials, of which the largest were conducted in USA and Europe. The results of these major randomized controlled trials are highlighted below:
- European Randomized Study of Screening for Prostate Cancer (ERSPC) – Results showed that screening reduced mortality due to prostate cancer by 20%. When the benefits were evaluated against the harms of treating indolent cancers (that may never harm the patient during his natural life span) resulting in sexual dysfunction, bowel, and urinary problems, the reduced mortality rate seemed insignificant.
- American Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) – Results showed no benefits with PSA screening.
Eminent Voices both For and Against PSA
Otis Brawley, CMO, American Cancer Society, has openly expressed his skepticism over the use of PSA screening and in the wake of task force’s recommendations, many of his colleagues joined him in his opinion. With Richard Ablin, the inventor of the PSA test himself claiming the test to have become a ‘public health disaster’, this may significantly dent the current position of conducting PSA routinely in men above 50.
However, there are many physicians like James Mohler, Associate Director, Roswell Park Cancer Institute in Buffalo, who argue that the test can save a man or at the best reduce his chances of dying due to prostate cancer. PSA advocates are worried that if men reject screening, malignant cancers may go undiagnosed. Eminent people like Joe Torre (Former Yankees Manager), Rudolph W. Giuliani (former New York City Mayor), Michael Milken (financier) claim, along with tens and thousands of others that the PSA test saved their lives.
The dueling narratives boil down to the way each side perceives the harm that can be caused when compared to the collateral damage due to test and subsequent treatment.
A growing number of physicians including Brawley echo that:
“Make sure men fully grasp the downstream decisions they may face as a result of screening — the risk of knowing too much. Studies have found that when men are given balanced information about both the cons and pros of P.S.A. testing, they are less likely to opt for screening than men who were merely offered the test. If a man understands the risks and benefits and does not want to be screened, that decision should be supported.“
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