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Tuesday, Sep. 23, 2014

PSA decision remains between patient and his doctor

Tuesday, May 22, 2012

Don't just do something, sit there.

That's good advice in some situations, but difficult to take when cancer may be involved.

Yet that's what the U.S. Preventive Services Task Force is saying when it comes to PSA blood tests.

Urologists were up in arms when the task force first floated the idea last fall that routine PSA blood tests may do more harm than good, but the group stuck to its guns.

Guidelines published Monday said there's little if any evidence that prostate-specific antigen tests saves lives, but there is a risk that a positive PSA test may trigger unnecessary treatments that cause men to suffer impotence, incontinence, heart attacks and even death from treatment of tiny tumors that would never have killed them.

It's not a mandate -- Medicare will continue to pay for the simple PSA blood test -- and the American Cancer Society has long urged men to decide the issue for themselves.

But the task force's recommendation is another sign that healthcare is moving more to limit treatments to those that actually extend lives, and quality of life.

While high PSA levels may mean prostate cancer is developing, it can also mean a benign enlarged prostate or an infection -- only a biopsy can tell. Experts point out that some 240,000 U.S. men are diagnosed with prostate cancer each year, but most with slow-growing tumors that carry a very low risk of becoming a dangerous cancer. Most men will get prostate cancer if they live long enough, experts say.

The task force analyzed earlier research, including two huge studies in the U.S. and Europe. The conclusion:

* Without screening, about 5 in every 1,000 men die of prostate cancer over 10 years. The European study found PSA testing might prevent one of those deaths, while the U.S. study found no difference.

* Of every 1,000 men screened, two will have a heart attack or stroke from resulting cancer treatment, and 30 to 40 will experience treatment-caused impotence or incontinence.

* Of every 3,000 men screened, one will die from complications of surgery.

Rather than stopping routine PSA screening altogether, some critics of the task force recommendation favor "active surveillance," detecting the tumors early and treating them only if they grow. According to the National Institutes of Health, that would mean some 100,000 men a year would be urged to not "just do something, sit there."

In the end, the decision remains where it should be, between a doctor and patient.


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