MDNews - Greater Kansas

++++++++++++++++++++++++++++ +++ +++ ++++++++++++++++++++++++++++ ONCOLOGY SPOTLIGHT + + PSA TESTING: IN CAN WE LIVE WITHOUT IT? THE UNITED STATES PREVENTIVE SERVICES TASK FORCE (USPSTF) RECENTLY ISSUED AN UPDATE TO ITS 2008 RECOMMENDATION ON PROSTATE CANCER SCREENING USING PROSTATE-SPECIFIC ANTIGEN (PSA) TESTS. MAY 2012, THE task force gave PSA-based screening for prostate cancer a "D" grade, recommending that physicians not offer the test for this purpose. Use of the test for post-diagnosis or post-treatment observation of men with prostate cancer was not included in this recommendation. "Prostate cancer is a serious health problem that affects thousands of men and their families. But before getting a PSA test, all men deserve to know what the science tells us about PSA screening," states Michael LeFevre, M.D., M.S.P.H., USPSTF Co-Chair, in a statement accom- panying the recommendation. "There is a very small potential benefit and signifi cant potential harms. We encour- age clinicians to consider this evidence and not screen their patients with a PSA test unless the individual being screened understands what is known about PSA screening and makes the personal deci- sion that even a small possibility of benefi t outweighs the known risk of harms." The recommendation statement highlights the fact that, while prostate cancer will affect an estimated 15.9% of men living in the United States, the risk of dying from prostate cancer is only 2.8%. At the heart of the USPSTF's recommenda- tion is the fact that PSA screening can result in a false-positive test, which could lead to invasive procedures that may do more harm than good. According to the USPSTF, harms associated with screening alone include infection, fever, bleeding and urinary issues associated with prostate biopsy, among others. Additionally, according to studies referenced by the USPSTF, "fi ve in 1,000 men will die within one month of prostate cancer surgery and between 10 and 70 will have serious complications but survive." Erectile dysfunction and urinary incontinence, along with a host of other negative effects, strike 200 to 300 of 1,000 men after surgical intervention for prostate cancer. As stated in the recommendation, prostate cancer is diagnosed in 70% of its victims after 75 years of age and is rare in men younger than 50, so the primary demographic that screening benefits is, conversely, also the demo- graphic that potentially suffers most from long-term adverse effects caused by further testing and treatments for positive or false-positive tests. Studies referenced in the report show that 90% of men who have PSA-test- detected prostate cancer receive early treatment. While critics argue that early detection directly correlates with better outcomes, the USPSTF counters with statistical evidence showing that positive or false-positive tests are directly linked to adverse psychological conditions. ■ MDNEWS.COM ■ MD NEWS Greater Kansas | 5

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