Panel's PSA test recommendations spark debate among doctors, cancer survivors
(CBS News) The United States Preventive Services Task Force announced in its final recommendation Monday that healthy men should no longer get screened for prostate cancer with a prostate-specific antigen (PSA) test because a resulting diagnosis may do more harm than good.
U.S. panel recommends against PSA tests for screening prostate cancer in men of all ages
Health experts: Routine PSA tests for prostate cancer not good for health
PSA debate: "Some people are going to get killed"
The panel said with a positive PSA test, risks of harmful side effects from treating prostate tumors that may be too slow-growing to ever cause a problem were more likely for men than the risk of dying from prostate cancer.
Evidence cited by the panel includes an 11-year study of 180,000 men that found more than 1,000 had to be screened with a PSA test to prevent a single prostate cancer death. The panel also found in another study for every 1,000 men who get a PSA test, 30 to 40 will develop erectile dysfunction or urinary incontinence, two men will experience a major cardiovascular event such as a heart attack caused by treatment, and one man will develop a potentially deadly blood clot in his leg or lungs from treatment. The guidelines were published in the May 21 issue of the Annals of Internal Medicine.
The recommendations aren't mandated, and the Obama administration said Monday that Medicare will continue to pay for the simple blood test, the Associated Press reported. Other insurers tend to follow Medicare's lead.
Reaction following the announcement has been mixed among the medical community and patients.
CBS News medical correspondent Dr. Jon LaPook reported on theCBS Evening News on Monday that yesterday's announcement sparked fury at the American Urological Association (AUA) annual meeting in Atlanta.
"The AUA is outraged and believes that the Task Force is doing men a great disservice by disparaging what is now the only widely available test for prostate cancer, a potentially devastating disease," the association said in a written statement. Its position is that, "when interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging or risk assessment and monitoring of prostate cancer patients."
The decision should be one that men discuss in detail with their urologists, the AUA said.
Dr. Peter Shlegel, chairman of urology at New York-Presbyterian/Weill Cornell Medical Center in New York City who attended the meeting, told HealthPop, "Death rates from prostate cancer have dropped dramatically in the U.S. despite an aging population, which suggests evaluation and early treatment of prostate cancer is valuable in saving lives." Referencing high-risk patients, such as African Americans who face a higher prostate cancer risk, Shlegel added, "There will be more people who die of prostate cancer because of the application of these study results," he said.
Task Force Chair Dr. Virginia Moyer, a professor of pediatrics at Baylor College of Medicine in Houston, told the AP of her group's guidelines, "We don't want this to be the answer. We want to screen for the ones that are going to be aggressive, manage those early - and leave everyone else alone," she said.
Dr. Michael Lefevre, a member of the task force who is associate chair in the department of family and community medicine at the University of Missouri School of Medicine, told CBS News of the backlash, "We have been taught for years to fear cancer and that only hope is early detection and treatment," Lefevre said. "And so for both doctors and patients alike, it's difficult to accept that some cancers don't need to be discovered and don't need to be treated."
Dr. Lee Green, a primary care physician at the University of Michigan also thought fear played a role.
"Cancer is a fear word," Lee told MedPage Today. "People have a need to believe, a need to feel that we have some power over this terrible disease," he said. "Admitting the truth, that PSA screening doesn't really save lives, is unacceptable because it takes that away."
In a CNN editorial, Dr. Otis W. Brawley, chief medical and scientific officer of the American Cancer Society, wrote that over the past two decades, more than 1 million American men have received unnecessary treatments causing side effects - some life-threatening - because of mass prostate cancer screening with a PSA test. He called screening a "lucrative business," alluding to financial benefits for hospitals because positive tests lead to more hospital visits and treatments, and resulting side effects may too lead to more visits and treatments.
"While I hope that this new recommendation will put an end to mass screening, I am not optimistic,"said Brawley. "As Upton Sinclair once said, 'It is difficult to get a man to understand something, when his salary depends on his not understanding it.'"
Brawley, who was not on the task force, also went on CBS This Morning Tuesday to discuss his thoughts on the guidelines. He said he would prefer to see selective-screening within a physician-patient relationship in which men are told the risks and benefits of a PSA test and are free to decide.
"We need to not dupe men into thinking that there's always benefit with this and everyone's going to get help. Some people are going to get killed because they get the test," he said.
What do prostate cancer survivors think?
Dr. Bruce Chabner, a physician at the Massachusetts General Hospital Cancer Center in Boston who survived prostate cancer told MedPage Today, "Would I still be alive and free of disease without PSA testing and treatment?" he asked. "I don't know, but I suspect that at the very least I would not be free of metastatic disease, as the PSA was going up, and the tumor was growing."
ESPN analyst Digger Phelps, former basketball coach at Notre and a man who was diagnosed with prostate cancer two years ago, described on CBS This Morning the "living hell" of the unknowns he felt when doctors discovered cancer after a PSA test.
He said the panel's recommendation is a "a step backward and you're going to see more guys putting off the awareness of check yourself out," Phelps said. "I disagree because I'm a survivor."
The heated debate continued into the commercial break, with cameras still rolling. Watch more from CBS This Morning:
