Healthy men don’t need PSA testing for prostate cancer, panel says

(Michael Temchine/FOR THE WASHINGTON POST) - A man receives radiation treatment for prostate cancer at Chesapeake Urology in Owings Mills, Md., in February. The laser is used to line him up to ensure he receives treatment in the proper location.

Most men should not routinely get a widely used blood test to check for prostate cancer because the exam does not save lives and leads to too much unnecessary anxiety, surgery and complications, a federal task force has concluded.

The U.S. Preventive Services Task Force, which triggered a firestorm of controversy in 2009 when it raised questions about routine mammography for breast cancer, will propose downgrading its recommendations for prostate-specific antigen (PSA) for prostate cancer on Tuesday, wading into what is perhaps the most contentious and important issue in men’s health.

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Task force chairwoman Virginia Moyer said the group based its draft recommendations on an exhaustive review of the latest scientific evidence, which concluded that even for younger men, the risks appeared to outweigh the benefits for those who are showing no signs of the disease.

“The harms studies showed that significant numbers of men — on the order of 20 to 30 percent — have very significant harms,” Moyer, a professor of pediatrics at Baylor College of Medicine, said in a telephone interview Thursday.

The 16-member independent panel is organized by the Department of Health and Human Services to regularly assess preventive medical care. Its recommendations have a widespread impact, especially on what services Medicare and private insurers pay for. The group’s influence was enhanced by the new federal health-care law, which will base some of its requirements for coverage on the group’s ratings.

The proposed recommendations come as doctors, researchers and policymakers are increasingly questioning whether many tests, drugs and procedures are being overused, unnecessarily driving up health-care costs and exposing patients to the risks of unneeded treatment.

Prostate cancer strikes more than 218,000 U.S. men each year. About 28,000 die of it, making it the most common cancer and second-leading cancer killer among men.

Although prostate cancer can be detected with a physical examination of the prostate, PSA testing has become the most common way that a diagnosis is made. The test measures a protein in the blood produced by prostate tissue and has significantly increased the number of prostate cancer cases being diagnosed at very early stages. But it has been a matter of intense debate whether that translates into a reduction in the death rate from the disease. Prostate cancer often grows so slowly that many men die from something else without knowing they had it.

Because it is not clear precisely what PSA level signals the presence of cancer, many men experience stressful false alarms that lead to unnecessary surgical biopsies to make a definitive diagnosis, which can be painful and in rare cases can cause serious complications.

Even when the test picks up a real cancer, doctors are uncertain what, if anything, men should do about it. Many men are simply monitored closely to see whether the tumor shows signs of growing or spreading. Others undergo surgery, radiation and hormone treatments, which often leave them incontinent, impotent and experiencing other complications.

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