Should Men Really Get Prostate-Cancer Tests?

A panel says that men over age 50 should avoid them, but some doctors believe that recommendation puts black men at risk.

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A federal panel's controversial recommendation that healthy men older than 50 avoid a PSA-based prostate screening test is drawing scorn from some doctors.

The U.S. Preventive Services Task Force, an independent panel of medical experts, evaluated studies involving 300,000 men conducted in nine countries, including the United States, to issue its determination that PSA screenings, which measure prostate-specific antigen levels, do more harm than good. The panel concluded that while the PSA test can point to the presence of cancer, it cannot distinguish aggressive cancers that kill quickly from the vast majority of prostate-cancer cells that grow so slowly that men will die from other causes.

Proponents of the test argue that it has saved countless lives by providing early diagnosis of a silent cancer, adding that the screening is especially important for African-American men, who are more than twice as likely as white men to die from prostate cancer.

"It would be a major setback if men only saw a headline that says 'Don't Get a PSA Test,' " said Dr. Gerald L. Andriole Jr., chief of urologic surgery at Washington University in St. Louis. Andriole is a principal investigator of one of the clinical trials the federal panel analyzed during its evidence review. Preliminary results from the trial indicate that routine PSA screenings do not lower prostate-cancer deaths among men ages 55 to 74. "There are many men who do benefit from PSA testing," Andriole said. "To totally ignore it sets the hands of progress back."

The American Urological Association acknowledged that not all prostate cancers require active treatment, but by "disparaging" PSA testing, the panel did a "great disservice to the men worldwide who may benefit." The Maryland-based association represents more than 18,000 urologists worldwide.

Dr. Marc Siegel, a practicing internist and author of The Inner Pulse: Unlocking the Secret Code of Sickness and Health, called the panel's recommendation "reckless" in an opinion column published by USA Today.

Despite the test's high error rates, "PSA is all we have, and we would be fools not to use it, as the panel recommends," Siegel wrote. He agrees that a new test is needed but tells The Root that in the meantime, PSA testing is useful, "especially in the African-American community because there is a high incidence of prostate cancer."

But some doctors support the government panel's recommendation. The common perception that PSA-based screening reduces deaths is not supported by the science, said Dr. Michael L. LeFevre, co-vice chairman of the USPSTF. "That is a hard conclusion to accept," LeFevre said during an Oct. 14 conference call. "But that is what the best science is telling us."

Dr. Otis Brawley, chief medical officer of the American Cancer Society, said that he feels vindicated by the panel's call for informed decision making, which matches what he's been saying for decades. "What has happened for the last 20 years is people have lied. People have exaggerated, for various reasons, and people have actually criticized me for simply saying what is scientifically known," Brawley said. At 52 and African American, he's at higher risk, but -- like many internists and urologists -- he skips PSA screening.

The panel found that 90 percent of men diagnosed with prostate cancer underwent treatments with the potential to cause serious harm. For every 1,000 men who underwent surgery to remove prostate cancer, five died soon after from complications. Up to 70 cancer survivors suffered serious consequences after surgery, such as heart attacks and strokes. Some 200 to 300 per 1,000 treated men were left impotent, incontinent or both.