As part of the task force evaluation, a team of researchers at the Oregon Health and Science University conducted an exhaustive review of the scientific literature about PSA testing, including five studies of screening and 26 studies of treatment.
“After about 10 years, PSA-based screening results in small or no reduction in prostate cancer-specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary,” the 116-page review concluded.
The task force plans to recommend downgrading of PSA testing to a “D” rating. The D rating means that “there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits,” according to the task force Web site.
The task force’s new proposed recommendations drew immediate criticism from those convinced that routine screening is necessary.
The “decision of no confidence on the PSA test by the U.S. Government condemns tens of thousands of men to die this year and every year going forward if families are to believe the out-of-date evidence presented by the USPSTF,” said Skip Lockwood, chief executive of Zero, a patient-advocacy group. “A decision on how best to test and treat for prostate cancer must be made between a man and his doctor. This decision is coming from a panel that doesn’t even include a urologist or medical oncologist.”
Several other experts agreed.
“The bottom line is that we should encourage screening because it will give men the full range of options to avoid death from prostate cancer,” said William J. Catalona of the Northwestern University Feinberg School of Medicine.
J. Brantley Thrasher of the University of Kansas Medical Center said, “It appears to me that screening is accomplishing just what we would like to see: diagnose and treat the disease while it is still confined to the prostate and, as such, still curable.”
But others praised the new report, saying it would save many men from unnecessary suffering.
“Unfortunately, the best evidence is that while some men might be helped by screening, others would be harmed, and on balance the test is not useful overall,” said Howard Brody of the University of Texas Medical Branch in Galveston.
Otis Brawley, chief medical officer at the American Cancer Society, would not comment on the task force’s recommendations but said: “I have long been concerned, and it has been very apparent for some years, that some supporters of prostate cancer screening have overstated, exaggerated and, in some cases, misled men about the evidence supporting its effectiveness. We need balanced, truthful information to be made widely available to physicians and patients when making important health decisions. Sadly, that has not happened with this disease.”
Staff writer Brian Vastag contributed to this report.
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