Task Force Advises Against PSA Test

Oct. 12, 2011 - An important government advisory panel has weighed in against a screening test for prostate cancer, saying it does not help save lives in men who have no symptoms of the disease.

The recommendation by the U.S. Preventive Services Task Force (USPSTF) was released this week in draft form. The final recommendation will come after a period for public comment ends on Nov. 8.

Prostate cancer is the most common form of cancer diagnosed in men after skin cancer. Most prostate cancer is found in men older than 65, and most deaths from this cancer occur after age 75.

Screening for cancer

Prostate cancer screening currently is done through a blood test that looks for the prostate-specific antigen (PSA), a digital rectal exam, and possibly an ultrasound. The task force acknowledges that the PSA test does find many cases of prostate cancer in men who don't have any symptoms of the disease. But after looking at the results of five trials involving tens of thousands of men, the USPSTF says that most of the tumors found through the PSA test are so slow growing that men will die from another cause.

For men ages 70 and older, the PSA test doesn't prolong their life, the task force says. For men ages 50 to 69 years old, the test at best only minimally prolongs life.

"Unfortunately, the evidence now shows that this test does not save men's lives," says Virginia Moyer, M.D., at Baylor College of Medicine and chair of the task force.

Unnecessary testing

In addition, the task force points out that the PSA test often produces false-positive results. Men with false-positive results are more likely to have unnecessary additional testing, including biopsies.

For these reasons, the task force says it won't recommend the test for men without symptoms. Currently, men are advised to get regular PSA testing, beginning at age 50.

The USPSTF did not evaluate how effective the PSA test was for men with symptoms or its use after diagnosis or treatment.

Not the final word

Otis W. Brawley, M.D., chief medical officer of the American Cancer Society, cautions that the task force's decision is not yet set in stone.

"It is important to keep in mind that under the new USPSTF process, the recommendation is not final until the conclusion of the public comment period and the USPSTFs review of those comments," Dr. Brawley says.

He adds that men must have an opportunity to make an informed decision with their health care provider about screening for prostate cancer after they receive information about the uncertainties, risks, and potential benefits associated with testing for early prostate cancer detection.

In general, all men are at risk for prostate cancer. But certain risk factors increase the likelihood that this cancer will develop:

• Age. Nearly two-thirds of all prostate cancers are diagnosed in men older than 65.
• Ethnic background. Prostate cancer is more common among African-American men than it is among white men.
• Diet. Some studies suggest that men who eat a high-fat diet may have a greater chance of developing prostate cancer.
• Obesity. Being obese puts a man at risk not only for prostate cancer, but for other cancers as well.
• Family history. Having a father or brother with prostate cancer more than doubles a man's risk of developing this disease.

Always talk with your health care provider to find out more information.