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Say no to PSA screenings, USPSTF says

by Brendon Nafziger, DOTmed News Associate Editor | May 22, 2012
The U.S. Preventive Services Task Force no longer advises men to screen for prostate cancer with prostate-specific antigen tests, in a decision that has been slammed by a major urologist society.

"A better test and better treatment options are needed. Until these are available, the USPSTF has recommended against screening for prostate cancer," the 16-member panel said in its final recommendations, released Monday.

The recommendations are a follow-up to draft guidelines the USPSTF floated in October, and which were open for public comment.

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Based on a review of the evidence, the group says PSA screenings do more harm than good, giving the screenings a "D" rating. For one, the tests have a high false positive rate, which could lead healthy men to undergo potentially risky surgical biopsies. Also, PSA tests lead to the "overdiagnosis" of prostate cancer. That is, many cancers are slow-growing and would never cause a problem, but as there's no reliable way to distinguish these from more vicious cancers, all men with detected cancers are treated.

And these treatments have side effects. According to a USPSTF fact sheet, for every 1,000 men screened and treated, 30 or 40 will develop erectile dysfunction, two will experience a heart attack or other cardiovascular event, and one will develop a blood clot. For every 3,000 men treated after screening, one will die from surgical complications.

As for benefits, the USPSTF said a large U.S. study, the U.S. Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, showed no benefit, whereas a large European study, the European Randomized Study of Screening for Prostate Cancer, suggested you would need to screen more than 1,000 men to save one life.

Urologists disagree

The American Urological Association, in a response issued after the USPSTF recommendations dropped, said it was "outraged."

"It is inappropriate and irresponsible to issue a blanket statement against PSA testing, particularly for at-risk populations, such as African American men," Dr. Sushil S. Lacy, AUA's president, said in a statement. "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."

In her statement, Lacy said that updated data to the European Randomized Study found screening was associated with a 21 percent risk reduction for prostate cancer-related death. She also said that prostate-specific mortality declined 40 percent in the United States over the past 20 years of PSA screenings, even though treatments for the cancer had not undergone a "substantial change," suggesting the mortality benefit was mostly from the screenings letting doctors find cancers early, when they were more treatable.

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