Know benefits, risks of prostate cancer testing

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In May, the U.S. Preventive Services Task Force, an independent group of national experts that provides evidence-based recommendations to improve Americans’ health, made an announcement that was widely debated by cancer communities and men everywhere.

The announcement was this: The U.S. Preventive Services Task Force recommends against prostate-specific antigen-based screening, or a PSA test, for prostate cancer. The potential benefit does not outweigh the expected harms.

A simple blood test and the PSA screening, combined with a digital rectal exam, has been relied on for the past two decades as an easy method to evaluate men’s risk for prostate cancer, although its accuracy and efficacy for decreasing the risk of prostate cancer death has long been a matter of debate. This announcement understandably caused confusion, doubt and even anger among men in general and prostate cancer survivors in particular.

But it’s an announcement that perhaps has been a long time coming.

WHAT THE TASK force really found is that too many of us have been relying too much on the PSA test. As a screening tool, it has always been somewhat controversial.

The PSA test frequently leads to the detection of slow-growing, nonlife-threatening prostate cancers (referred to as “overdiagnosis”), putting men at risk for more invasive tests and unnecessary therapies that can cause pain and health problems. In addition, many other factors besides cancer can raise PSA levels, including infection, certain medications and a benign enlargement of the prostate that often occurs with age.

As a result, about 100 to 120 out of every 1,000 men screened will receive a false-positive test – in other words, the test may suggest they have cancer when in fact they don’t. This can cause anxiety and worry. It also can lead to other tests, including invasive biopsies that surgically remove tissue samples and may cause complications such as infection (which may sometimes be life-threatening), bleeding, urinary problems and pain.

The PSA test also can lead to overly aggressive treatment. The fact is, most prostate cancers – nearly 63 percent – occur in men 65 and older. Because most prostate cancers are slow-growing, these men more likely will die from old age or other health problems than from this type of cancer. But since there’s also no sure way to tell which cancers are aggressive, many men choose to receive invasive treatments that often lead to permanent urinary and sexual dysfunction.

SO WHAT SHOULD men do? Certainly, the PSA test has been overused. But it can be helpful for men in certain risk categories. These categories include men 50 or older who:

• have one or more first-degree relatives (a father or brother, for example) who were diagnosed with prostate cancer before age 60;

• have one or more first-degree relatives who died of prostate cancer before age 75.

Still, even in these men, it is important to note that it remains unproven whether any benefits of screening outweigh the harms.

However, a more personalized approach to screening will help target men who should more concerned about their risk of prostate cancer. Based on the test results, physicians also can talk to men about their options. Not all men with prostate cancer may need cancer treatment right away. Careful periodic monitoring for signs of cancer progression might be the best first step.

Finally, the task force’s recommendation underlines how important it is for all of us to be informed about the benefits and risks of any screening test. Some men may still opt for the screening after their physicians have carefully explained the potential risks and benefits.

(The writer is director of the Georgia Health Sciences University Cancer Center, and has more than 22 years’ experience in cancer research and treatment, including in the Cancer Vaccine Section at the National Cancer Institute. September is Prostate Cancer Awareness Month.)


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