LITTLE ROCK — Another diagnostic test is being reconsidered, and it’s one that is likely to elicit as much passion and disagreement as the recent recommendations on mammograms.
The influential government group, the United States Preventive Services Task Force, recommends that healthy men of any age no longer be screened for prostate cancer by measuring the prostate-specific antigen (PSA) in the blood.
The test is part of a routine annual physical and many men are tested without their knowledge. The Preventive Services Task Force maintains that the test does not save lives, and it often leads to more tests, including biopsies and treatment for prostate cancers, that cause pain, impotence and incontinence.
Based on the PSA test,more than 1 million prostate biopsies are performed annually, and for every 12 biopsies done, three cancers are identified. If a cancer is diagnosed, it is almost always treated by prostatectomy, irradiation or implanting radioactive seeds. Afterward many receive drugs to stop testosterone production. And because of new surgical techniques, urologists are doing more prostatectomies than ever.
The task force maintains that in most patients, the cancer is slow growing, israrely symptomatic during the patient’s lifetime and is best left alone as the cancer virtually never causes death. And identifying more aggressive cancers earlier by measuring the PSA does not appear to increase the chances of cure. In other words, doing the test does not save lives.
Between 1996 and 2005 more than a million men received surgery, radiotherapy or both to treat prostate cancer; 5,000 died soon after the surgery and between 10,000 and 70,000 had serious complications. More than 500,000 men have persistent blood in their urine and between 200,000 and 300,000 have either impotence, incontinence or both.
For those who are treated with medications, side effects include fatigue, weakness, loss of libido and reductions in quality of life. Not surprisingly, many experts believe that the use of the PSA test has led to disastrous consequences for many men. A great deal of pain and suffering, millions of surgeries that are of no benefit and billions of dollars spent unnecessarily. According to Dr. Richard Ablin, who discovered the prostate-specific antigen, its use is nothing short of a public health catastrophe.
The task force made its recommendations after a panel of experts carefully evaluated all the available evidence on the effectiveness of the PSA measurement to improve quality of life and longevity in patients with prostate cancer. Their conclusions are based on two very large research studies conducted in Europe and the United States.
According to the task force report, both studies demonstrate conclusivelythat if any benefit does exist, it is very small after 10 years. In the European trial, 182,000 men in seven countries either did or did not receive PSA tests. During a nine-year period, the PSA test did not reduce death rates from prostate cancer in all of the men studied, although a very small benefit was noted in the 55-69 age group. In the United States, 76,693 men were followed, and over a 10-year period no improvement in death rates was noted.
Rest assured that the urological community that diagnoses and treats prostate cancer, its advocacy groups, and people who have had prostate cancer diagnosed by the test, will strongly disagree. Already, prostate cancer experts and have come out with statements that the evidence is compelling, at least for men underage 65, that the PSA test does indeed save lives by identifying cancer early.
A good example is Michael Milken, whose large foundation supports prostate cancer research. He is convinced that without the PSA test he would be dead.
Personally, I will go with the science rather than the passion of anecdotal stories of lives saved. The science requires that we do more to identify better and more accurate ways to diagnose and treat aggressive prostate cancer that annually kills more than 20,000 men. More research is the answer. Until then, having a test that does more harm than good is just not worthwhile.
Dr. David Lipschitz is the director of The Longevity Center at St. Vincent Infirmary Medical Center. More information is available at:
drdavidhealth.com
High Profile, Pages 43 on 10/23/2011