PSA tests falling out of favor

One-size-fits-all medicine suffered another blow with the announcement Friday that a routine blood test prostate cancer should no longer be routine.

PSA -- prostate -specific antigen tests, once recommended routinely for men after a certain age -- should never be done without consulting with a doctor first, said the American Urological Association.

In an about face, the AUA said healthy men under 55 don't need routine annual screening, nor do men 70 and above. And, men 55 to 69 who are considering the PSA should consult their doctors about the test's benefits and risks.

The new recommendations are based strictly on medical evidence from carefully designed and conducted clinical trials, which suggests that PSA screening may prevent one death from prostate cancer for every 1,000 men screened over a 10-year period.

At the same time, however, many men who undergo PSA screening will be harmed because of treatments that can lead to incontinence, impotency, or through infections or other complications from prostate biopsies.

The AUA's new recommendation is more in line with those by the American Cancer Society and five other medical groups that promote "shared decision-making" with doctors about risks and benefits of PSA tests. The U.S. Preventive Services Task Force and two other groups recommend that men skip screening altogether.

As medical costs are shifted, more and more to the taxpayers, it's important that money is used where it is proven to do the most good for the patient. Too many tests are ordered needlessly, putting the patient at risk, only to be used in court in case the patient has a bad outcome.

It will be difficult to overcome such "defensive medicine" and promotion by vested interests of technology and medications that are at best only marginally better than lower-cost options.

But Friday's recommendation is a sign that good medicine has a chance.