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Lay Off the PSA, USA Medical Panel Advises

Published May 21, 2012 10:58 PM by Glen McDaniel

The US Preventive Services Task Force is recommending that healthy men should not be routinely screened with the PSA test. There has been a buzz that this decision was in the offing for several years now, so the final ruling is not a surprise to  many.

The logic of course is that the test has a high degree of nonspecificity and is not  all that sensitive either. An estimated 13% of patients screened with the PSA will receive a false positive result. Further, over 10 years, 20% of all men who undergo a PSA test will end up receiving more invasive testing like one or more biopsies.

In addition to the resulting stress and label of "possible cancer" a biopsy can cause bleeding, infection, pain, fever and urinary problems. What a price to pay for  a false alarm.

I have a friend who went through such a scare over 15 years ago at age 40.  His physician was quite aggresive and when his PSA velocity (change from one annual visit to the next) was high he was talked into undergoing surgery and  placement of radioactive seed implants in his prostate. He suffered from nausea, bleeding, urinary incontinence and impotence. He suffered sever depression and could not work fat his regular job or a couple of years.

Luckily he found a new physician who told him to practice "watchful waiting" and has reasssured him that he will probably die of old age before he dies of prostate cancer.  Today he is an otherwise healthy and asymptomatic 55 year old  very active professional. Well over 60% of prostate cancers grow very slowly and  can in fact go undetected with no adverse effect.

Some medical groups are not in favor of this radical  no-PSA approach. The American Urological Association  ( whose members perform much of the prostate surgery)   recommend digital rectal examination (DRE) and PSA for men over 40. The American Cancer Society advocates educating older men about prostate cancer and screening in those at high risk such as those over 50 years old, those  with a family history of prostate cancer, and African Americans for example.

It is always a good patient-centered move when tests are evaluated for specificity, sensitivity and clinical effectiveness. As scientists it is our job to keep abreast and  be able  to act as resources for clinicians and patients on these matters.






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