Routine screening for prostate cancer does not help save the lives of healthy men and often triggers the need for more tests and treatments, a US government health panel said Friday.
The US Preventive Services Task Force’s draft recommendations, which will be open to public comment on Tuesday, are likely to face a pushback from advocates of the PSA blood test as well as from drugmakers and doctors who benefit from the now-lucrative screening industry.
Based on the results of five clinical trials, the recommendation to avoid a prostate-specific antigen (PSA) test — which measures the level of the protein in the blood — applies to healthy men of all ages without suspicious symptoms.
But it could have an especially dramatic impact on the care for men aged 50 and older, who are routinely administered the PSA test.
“The low specificity of the PSA test coupled with its inability to distinguish indolent from aggressive tumors means that a substantial number of men are being overdiagnosed with prostate cancer,” the task force said.
“If any benefit does exist, it is very small after 10 years,” it added, citing two major trials in Europe and the United States on the value of PSA testing.
The task force also found no evidence that other forms of screening, such as an ultrasound or digital rectal exam or ultrasound, are effective. It did not examine whether testing was beneficial to men who have already been treated for the disease or who show suspicious symptoms.
One million men who had had the PSA test and would otherwise not have been treated got surgery, radiation therapy or a combination of both between 1986 and 2005, the task force said.
It pointed to evidence suggesting that up to five in 1,000 men will die within a month of prostate cancer surgery and between 10 and 70 in 1,000 men will suffer from serious complications.
“Radiotherapy and surgery result in adverse effects,” the task force added, noting that 200 to 300 in 1,000 men treated with such therapies have urinary incontinence or impotence.
An estimated 217,730 men in the United States were diagnosed with prostate cancer and 32,050 died last year of the second most common form of cancer in men after skin cancer.
But the task force noted that most men with the cancer only have “microscopic, well-differentiated lesions that are unlikely to be of clinical importance.”