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Federal panel pans PSA prostate test

One problem with the PSA test is that the level of PSA in the blood tends to rise with prostate enlargement or infection as well as cancer. (AP Photo/U.S. Postal Service)
One problem with the PSA test is that the level of PSA in the blood tends to rise with prostate enlargement or infection as well as cancer. (AP Photo/U.S. Postal Service)Read more
    by Marie McCullough, INQUIRER STAFF WRITER
    Published 

The commonly used test to detect prostate cancer saves few if any lives, and it prompts unnecessary treatment that leaves many men with impotence or incontinence, or both, according to an analysis from the U.S. Preventive Services Task Force published Monday.

The government-sponsored task force concluded that the harms of screening with the prostate specific antigen (PSA) test outweigh the benefits — even for African-Americans, who are at elevated risk of developing and dying of prostate cancer.

While recognizing that "some men will continue to request screening," the task force said doctors "should not offer or order PSA screening unless they are prepared to engage in shared decision-making that enables an informed choice by the patients."

Urologists and advocacy groups immediately decried the advice — as they did when a draft version was released last October — and worried that insurers may stop paying for PSA testing.

But other experts applauded the unflinching recommendation, pointing out that screening dilemmas have already led the medical community to turn away from automatic PSA testing. Even the American Urological Association recommends that testing be "individualized" and that men be informed about the risks of overdetection and overtreatment.

One of the most vocal critics of routine testing — Richard J. Ablin, 72, who discovered the prostate specific antigen in 1970 — was jubilant. For decades, he has said that using the blood protein to try to flag cancer in the walnut-sized reproductive gland is "hardly more effective than a coin toss." He says the test should be reserved to monitor prostate cancer patients for recurrence after treatment.

One problem with the PSA test is that the level of PSA in the blood tends to rise with prostate enlargement or infection as well as cancer.

Even with a "normal" PSA level, cancer can't be ruled out, and experts continue to debate where to set the cutoff, and how much to rely on abrupt changes in PSA levels rather than absolute numbers.