Editorial
October 10, 2011Questioning Prostate Cancer Tests
American men now have an authoritative warning that getting a blood test for prostate cancer may push them toward needless tests and treatments that would do them more harm than good. The United States Preventive Services Task Force, after an exhaustive review of the scientific evidence, has suggested that healthy men should no longer receive the P.S.A. blood test to screen for a protein that may indicate cancer.
The task force of 16 independent experts advises the Department of Health and Human Services on which screening tests have clinical benefits and which do not. It gave the P.S.A. test its lowest rating, a Grade D, because the harm caused by having it outweighs the benefits.
The test has become widely used because it can help detect tiny tumors at a very early stage, when they are theoretically most treatable. Unfortunately, a vast majority of the results are false-positives; the men don’t actually have cancer. And most of those found to have cancerous cells would not suffer ill effects because their cancer is so slow-growing that it would not cut short their lives. Those with faster-growing cancers may also not be helped if the cancer is extremely aggressive.
The biopsies given to patients with positive P.S.A. tests can cause infections and other adverse effects and the treatments can cause harm to many patients. Surgery to remove a tumor kills or seriously harms a small percentage of the patients. Both surgery and radiation therapy leave 20 percent to 30 percent of the patients impotent, incontinent or both. And drugs to block male hormones leave 40 percent with erectile dysfunction.
Critics, including urologists, who diagnose and treat prostate cancer, charge that the task force’s recommendations are misguided and will hurt patients. They have already been held up for two years lest they ignite charges of government rationing. That’s absurd. The recommendations are intended as guidance to help men and their doctors decide whether to use the test and how to react if it is positive. This is information patients need to know.
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