U.S told to end routine prostate cancer screening as it causes 'more harm than good'
12:16 GMT, 22 May 2012
Men who want a PSA test still can get one in the U.S, but only after the doctor explains the uncertainties
Healthy men over 50 should no longer have routine prostate cancer screenings because they do more harm than good, according to the U.S government.
A panel of specialists called the U.S. Preventive Services Task Force found that PSA blood tests are too unreliable, giving false positives 80 per cent of the time.
They cited a study that showed more than 1,000 men need to be screened to prevent a single prostate cancer death, many of whom will have needless treatment.
A final guideline says too many men suffer impotence, incontinence, heart attacks, occasionally even death from treatment of tiny tumors that never would have killed them.
European countries, including the UK, do not offer routine PSA screenings for these reasons.
However, men who want a PSA test still can get one, but only after the doctor explains the uncertainties. That is in part because the panel found PSA testing hasn't been studied adequately in black men and those with prostate cancer in the family, who are at highest risk of the disease.
The Obama administration said the government health care plan for the elderly will continue to pay for PSA screenings and other insurers tend to follow the government's lead.
Mark Weber, from the Department of Health and Human Services, said: 'This is important information for the public and men to have, and they should talk with their doctors about the risks and benefits of prostate cancer screening and make the decision that's best for them.'
The task force advice goes a step further than major health groups including the American Cancer Society, which has long urged that men decide the issue for themselves after being told of PSA's pros and cons.
PSA screening can pick up tumours that would never be life-threatening
Dr Virginia Moyer of the Baylor College of Medicine, who heads the taskforce, said the controversy would only end with the development of better tests – ones that will tell if men's tumours are likely to be life-threatening.
'We want to screen for the ones that are going to be aggressive, manage those early – and leave everyone else alone,' she said.
In an editorial published with the guideline in Annals of Internal Medicine, some urologists argue the panel underestimated PSA's value and overestimated its harms.
'What PSA screening offers the men is a substantial opportunity to avoid dying a particularly unpleasant death from prostate cancer,' said editorial co-author Dr William Catalona of Northwestern University, who pioneered the testing.
But Dr Otis Brawley, the American Cancer Society's chief medical officer, welcomed the task force's recommendation. He hoped it would help deter mass screenings.
'The question is, are we actually curing anybody who needs to be cured right now' Dr Brawley asked.
He said the risk of death is the same in Europe and the U.S. even though many more American men are screened, diagnosed and treated.
Too much PSA, or prostate-specific antigen, in the blood only sometimes signals prostate cancer is developing. However, it can also mean a benign enlarged prostate or an infection and a further biopsy is needed.
Most men will get prostate cancer if they live long enough with some 240,000 U.S. men a year diagnosed with it. However, most have slow-growing tumors that carry a very low risk of morphing into the kind that can kill.