U.S. Panel Advises Against Routine Prostate Test
Healthy men should no longer receive a P.S.A. blood test to screen for prostate cancer because the test does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence in many, a key government health panel has decided.
How can this be? Everyone knows that finding cancer early is important. The PSA test must save lives.
Those of us who study diagnostic tests understand that all tests have probabilities associated. A high PSA level does not mean that a man has prostate cancer. It means that he has an increased probability of prostate cancer. It also does not discriminate between aggressive prostate cancer and slow growing prostate cancer.
What do the studies tell us?
As the P.S.A. test has grown in popularity, the devastating consequences of the biopsies and treatments that often flow from the test have become increasingly apparent. From 1986 through 2005, one million men received surgery, radiation therapy or both who would not have been treated without a P.S.A. test, according to the task force. Among them, at least 5,000 died soon after surgery and 10,000 to 70,000 suffered serious complications. Half had persistent blood in their semen, and 200,000 to 300,000 suffered impotence, incontinence or both. As a result of these complications, the man who developed the test, Dr. Richard J. Ablin, has called its widespread use a “public health disaster.”
Many physicians have understood these results for several years. I have refused prostate cancer screening since turning 50, because I understood two factors – the test has mediocre characteristics and prostate cancer treatment has significant side effects.
Now many have and will decry this result. Many cannot believe that PSA testing could possibly do harm. But when one examines the data, the proper path becomes clear.
