But after reviewing the available scientific evidence, the task force concluded that such testing will help save the life of just one in 1,000 men. At the same time, the test steers many more men who would never die of prostate cancer toward unnecessary surgery, radiation and chemotherapy, the panel concluded.
For every man whose life is saved by PSA testing, another one will develop a dangerous blood clot, two will have heart attacks, and 40 will become impotent or incontinent because of unnecessary treatment, the task force said in a statement Monday.
Many middle-aged men regularly get the PSA test. But for years, some experts have questioned whether such screening saves lives. Monday’s statement finalizes a draft recommendation made by the task force last fall.
While not mandates, the group’s statements have widespread impact, especially on private insurers and Medicare.
The recommendation raises the question of whether a test deeply embedded in the medical landscape can be pulled back.
“It’s a tough message,” said Virginia Moyer, chairman of the task force and a professor of pediatrics at the Baylor College of Medicine in Houston. “Nothing would have made us happier than to have found that [routine PSA screening] really works.”
Moyer added that men who have urinary symptoms — such as pain or difficulty urinating — may still benefit from PSA testing.
“Our recommendation is not a recommendation to tell the patient to shut up and go away if they ask about” PSA testing, Moyer said. “Our recommendation is that it not be routinely offered.”
Officials at two large insurers said the companies are unlikely to cease coverage in the near future. Lori McLaughlin, a spokeswoman for WellPoint, said the company “considers continued screening for prostate cancer as medically necessary for men between the ages of 50 and 75” but will continue to review the evidence.
Tammy Arnold, a spokeswoman for Aetna, which considers PSA screening a medically necessary preventive service for men age 40 and older, said officials there will review their policies.
Specialists who diagnose and treat prostate cancer reacted swiftly. The American Urological Association said it was “outraged” by the recommendation. “Men who are in good health and have more than a 10-15 year life expectancy should have the choice to be tested and not discouraged from doing so,” the group said in a statement.
The Large Urology Group Practice Association, which represents 1,800 urologists, issued a statement saying it was “appalled” and called the recommendation “irresponsible and inexplicable.”