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Task force: PSA tests do more harm than good
May 21st, 2012
05:28 PM ET

Task force: PSA tests do more harm than good

The United States Preventive Services Task Force issued their final recommendation on the PSA prostate cancer-screening test Monday, recommending against routine PSA exams for men of any age. The task force says the PSA exam and additional treatments that may follow, like radiation and surgery, result in far more harm than benefit.

Dr. Virginia Moyer, who sits on the task force, cited that only one out of every 1,000 men who are screened would actually benefit from the exam. Instead, most will have to deal with side effects from treatment that can range from incontinence and impotence, to stroke and death.

“Your primary care physician shouldn’t routinely offer the exam," said Moyer. "But if a patient brings it up, that doctor has a responsibility to inform them of the potential harms and risk."

New story: Top American Cancer Society doctor weighs in on the announcement

However, the American Urological Association is not changing its stance on the PSA test.  “We at the AUA still recommend the PSA, with its imperfections," said Dr. Chris Amling. "It’s the wrong thing to deny a man if he wants to have this test."

Related: Value of mass prostate cancer screenings questioned

The PSA test measures the amount of prostate-specific antigens in the blood. While the screening detects the presence of prostate cancer, it cannot make the distinction between aggressive, fast moving cancers, and the more common slow growing ones.

“There is no other screening test for prostate cancer. It’s clear that the only way to cure prostate is to detect it early," Amling emphasized.

Related story: Annual prostate cancer test doesn't save lives, study says

According to the American Cancer Society, prostate cancer is the second deadliest cancer among men, and occurs most often in African-American.  But survival rates also are very high. The American Cancer Society finds that 91% of all men with prostate cancer will live for 15 years beyond diagnosis. According to the National Cancer Institute, 70% of prostate cancer deaths occur after age 75.

Dr. Otis Brawley, Chief Medical Officer of the American Cancer Society supports the recommendation of the task force.  “People need to realize that science hasn’t given us the answer," said Brawley. "In the past, when we don’t have a scientific answer, and we’ve guessed, we’ve hurt a lot of people."

Related story: Who decides about screenings?

The task force made its draft recommendation publicly available in October 2011, and reviewed nearly 3,000 comments before issuing its final recommendation.


soundoff (432 Responses)
  1. Lindsay

    The PSA test saved my dad's life. Initially had no signs or symptoms and went to his general physician for a physical. The doctor suggested a PSA given his age, 53. His PSA came back elevated and was completed a 2nd time weeks later, still elevated. He then had a biopsy which showed many of the samples were positive for cancer. He was diagnosed with Stage 2 – needing a radical prostectomy, chemo, and radiation. He's ~2 months out of treatment. The test saved his life. It's worth the time to get tested. I would never suggest that a man defer this test.

    May 22, 2012 at 18:07 | Report abuse | Reply
    • Patty

      I agree completely. It is a simple bloodtest and I am not sure what would have happened to my husband if his prostate cancer went untreated. His PSA went up and he had the biopsy which confirmed cancer of the prostate and then had a radical prostatectomy. It had spread to the seminal vesicle but not outside the capsule. That was 10 years ago and he is fine
      but I don't understand why anyone would stop the bloodtest. A biopsy can always be done to confirm.

      May 23, 2012 at 12:26 | Report abuse |
    • hankcarf

      The routine PSA saved my life, too. I was diagnosed with prostate cancer at 47. If I hadn't had surgery, it would have spread. These recommendations are absurd and irresponsible.

      May 23, 2012 at 16:58 | Report abuse |
  2. Fred

    The United States Preventive Services Task Force - Preventing Medical Services to American Citizens to Maximize Insurance Company Profits.

    It used to be that we only had Insurance Companies were refusing to provide necessary and appropriate medical care because they didn't want to pay for it. Now the Obamacare Death Panels are in lock step with the Insurance Companies to help remove anyone over the age of 40 or sick or handicapped. Won't be long before we have English Speaking Nazi like Death Panels.

    Way to go Obama. You so smart. And don't forget American's Obama says Dog is tasty, so we can expect it on our children's school lunch menu starting in 2013 because if it's good enough for Barry it's OK for you.

    May 22, 2012 at 19:14 | Report abuse | Reply
    • Kathy O'Rourke

      Seriously? I think you are a bit over the line on this. There are no government "Death Panels" and what in the heck does Obama having eaten dog have to do with the issue anyway?
      Perhaps you need to check your facts before you fly off on a tangent.

      May 22, 2012 at 19:22 | Report abuse |
    • Fred

      Kathy, just because they don't call themselves a death panel, doesn't mean the root purpose is to do that very thing. Naturally, Obamacare won't use such obvious labeling. Insurance companies don't either. But it's still what they are doing. If someone is too old, too costly to keep alive, they will find ways to convince you that you don't need treatment. It's no different than Hitler putting handicapped and retarded people to death in Nazi Germany and countries under it's control. Just because Obama doesn't wear a swastika doesn't mean that he doesn't dream of one.

      May 22, 2012 at 23:15 | Report abuse |
    • LJ

      It chills me to the core that I am part of a nation with people like Fred in it that can have a say in the direction of this country through their rights as citizens. They take something like the PSA, which they have no true understanding in regards to its cost/risk/benefit profile and is in the grand scheme of things a very inexpensive test, and politicize it sharply to the point of implying that this is death panel decision making. Bravo Bravo...

      God help this nation's people who are so blind in their passionate ideology that they are blind to anything that is not in their vein of belief.

      You see it here folks.. is this an argument for or against very expensive cancer therapy options that cost 6 figures all for a few more months of life? Or for some other reasonable argument that deeply afflicts our nation's policies and bioethics with vast cost/benefit scenarios? No!!! LOL He's protesting a few hundred dollar PSA.

      May 23, 2012 at 02:26 | Report abuse |
    • Chris

      This response is why blogging and online commentary has failed. How in the world did you politicize this into Obama being a dog eater, and that consequently, our children will be eating dogs in their school lunches? That's just absurd.

      If you disagree with the task force and their decision, then you are free to ignore it and get the exam. Yet I get the impression that you know little about it or the various positions behind it.

      May 23, 2012 at 10:17 | Report abuse |
    • Fred

      Eljay and Chris - Claiming there is no politics in this is "task force" is meaningless novelty on your part. And Eljay should be especially concerned about his prostate. You liberals need to put your heads where you have your "feelings" are. It may be fun for you to "feel" but it's a meaningless exercise to follow a government that has become and is working towards a "healthcare" system that kills it's patients because they might be too sick to be worth the cost.

      May 23, 2012 at 10:50 | Report abuse |
    • Chong

      Your tinfoil hat's come adrift again Fred. The G.W.Bush flat-earth society meeting will be held Thursday as usual.

      May 23, 2012 at 17:32 | Report abuse |
  3. Kathy O'Rourke

    Seems to me that these task forces should let docs take care of their patients. It is like there is an "acceptable kill ratio" as far as they are concerned. Interesting that the first person quoted from the "task force" was a woman... kind of like all the men on the Mammogram recomendation. Were there at least some Urologists on the "task force" ?
    Unbelievable that these people are trying to tell us how to live our lives and intrude into the doctor/patient relationship.

    May 22, 2012 at 19:19 | Report abuse | Reply
    • doctor doctor

      the doctor quoted is a PEDIATRICIAN and there were neither urologists nor oncologists on this panel

      May 23, 2012 at 18:39 | Report abuse |
  4. Snaporaz

    I smell a large rat here. First, despite the name, the USPSTF is NOT a government agency, like the CDC. It's a private organization. I wonder where its funding comes from? Second, the alarmist tone of the report reads like the tests themselves are dangerous. BS. The tests sometimes result in false positives – any responsible physician or patient would schedule further tests to make sure before rushing off to the ER. It's unnecessary treatment that is dangerous. Third, recommendations from one's physician (who knows your medical history) are more reliable than generalizing reports from a "task force".

    May 22, 2012 at 20:03 | Report abuse | Reply
    • Ashlee

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      September 14, 2012 at 00:57 | Report abuse |
  5. mensaboy

    I have a 40 year old friend who was saved by the PSA test.Sarah Palin was right about the death squads.

    May 22, 2012 at 22:15 | Report abuse | Reply
  6. ScottS

    I know about the high false detection rate, but I still like to have the option, and so I have the PSA test each year.

    By the way, Fred, this has nothing to do with the President. Please change the channel once in a while.

    May 23, 2012 at 00:00 | Report abuse | Reply
    • Fred

      Sorry buddy, it has everything to do with the fraud known by all as Obamacare. Your lack of appreciation to the federal political machine is sad and pathetic.

      May 23, 2012 at 11:12 | Report abuse |
  7. Allen O. Cottle, M.D.

    Those who are advocating no test should see how terminal patients suffer with bone metastases and often choose suicide.

    May 23, 2012 at 07:27 | Report abuse | Reply
  8. Bob

    The United States Preventive Services Task Force is funded, staffed, and appointed by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality. They are not independent, they are a government agency. Apparently their job is to cut lifesaving tests to save money for Obamacare. One of my best friends' life was saved by the PSA test. This is Obama killing people to save money.

    May 23, 2012 at 08:26 | Report abuse | Reply
    • peridot2

      That's a radical interpretation of the text. The article is simply stating that the PSA test is inaccurate and has too many false positives.

      May 24, 2012 at 01:46 | Report abuse |
  9. Robert P. Thiel, PhD

    I have been involved with the clinical development of the PSA test since the late 1980's. Yes the test is imperfect, but it was never intended to be a "screening" test for prostate cancer. In fact the FDA would not consider that "indication for use". Total PSA (and the Free PSA to Total PSA ratio test and the Complex PSA test)) were designed to help the Urologist determine who really needed to be biopsied. In that context the test perform "fairly" well. Can there be improvements? Of course, but we will have to wait for the next generation of assay's that are on the horizon. Until then, PSA is the best we have when used appropriately

    May 23, 2012 at 09:06 | Report abuse | Reply
  10. mworks

    i sure don't see them recommending stopping cancer screening for women! psa test saved my fathers life.

    May 23, 2012 at 09:57 | Report abuse | Reply
  11. Thegoodman

    As an engineer who worked for a prostate cancer treatment device company, in my opinion, all the hoopla surrounding prostate cancer is silly. 70% of prostate cancer cases are a non-lethal type of cancer that will take 10-15 years to "kill" the patient, who on average is diagnosed at the age of 70 yrs old, all the while doing very little to diminish their quality of life.

    Prostate cancer treatment is about improving quality of life, not saving lives. Incontinence and impotence are the important factors here, not life and death. While there are certainly men that get and die from prostate cancer earlier in life, they are the exception far more than the rule.

    The advocacy group is correct in that prostate cancer is big money and not necessarily big benefits for patients. A man that is 78 yrs old has no business undergoing a radical prostectomy, yet doctors will do it because they make $10k doing the procedure. That same 78 yr old would have a higher quality of life in his remaining years if he had received no treatment at all.

    May 23, 2012 at 10:23 | Report abuse | Reply
    • taskmaster

      I am 75 years old and I have a psa and manual every year.I want my doctors to tell me what I need, Not one of Obamas death panels. If I develop prostate cancer I want make my own decisions as to what treatment I do or do not take.

      May 23, 2012 at 10:43 | Report abuse |
  12. Matt

    This is a much more complicated question than it appears. Suppose you are 55 years old and you have an elevated PSA and a biopsy then shows Gleason 6 cancer. What do you do? Most men elect for immediate treatment. That's fine if it makes them feel better. But there is no evidence-based rationale for such a person to claim 10 years later that the surgery saved their life. The reality is that 90% would still be alive WITHOUT treatment. I'm for the screening, but we need more education and discussion about treatment options.

    Another way of looking at this - what if we just started removing all prostates at age 30? That should work, shouldn't it?

    May 23, 2012 at 11:53 | Report abuse | Reply
  13. CLE post

    Four and a half years ago my PSA jumped to 5. I had a biopsy and was told I had prostate cancer. I had a prostatectomy followed by a course of radiation. My PSA has been undetectable since that time. And these people want to tell me that I was harmed by my screening, surgery, and radiation? I had cancer! I wanted it gone! If I had been 72 it might have been a different story. I'd like to die of old age.

    May 23, 2012 at 13:16 | Report abuse | Reply
  14. Frank

    I was just diagnosed with prostate cancer, thanks to the PSA. My father died from it. There should be a national outcry against this, like there was when they tried to stop routine mamograms.

    May 23, 2012 at 13:27 | Report abuse | Reply
  15. Sun

    The first rule of medicine is DO NO HARM! Pushing tests and treatments for the benefit of the drug companies are doing harm. Do the blood test, fine, but follow up with a physical biopsy, instead of slamming the patient on drugs ahnd treatments they may or may not need.

    May 23, 2012 at 14:12 | Report abuse | Reply
  16. Whatever

    It seems to me your out of luck either way in so many cases. Prostate cancer testing, if you don't die from the cancer you could die from the treatment..and lately sleeping pills...you can die early or get cancer from sleeping pills or you can die early or get cancer from the stress of not sleeping. However you look at it no one gets out of here alive anyway.

    May 23, 2012 at 14:33 | Report abuse | Reply
  17. MollyMalone

    I come from a large family as does my husband. Prostate cancer sufferers in my family all had the PSA screening. Those who took the course of watchful waiting or advanced surveillance all died and they died in extreme pain. Those who had their prostate removed (My Father is in this group.) are either still living or died of other conditions. In my husband's family, his Father, older brother and he were all diagnosed with prostate cancer. This group either had their prostate removed (Father-in-law) or because of early detection, had radiation seeds implanted in their prostate (which has the least side effects). So, from just 2 families, it appears that having the PSA screening was crucial to their continued living IF they chose more aggressive treatment options. Why in the world would men stop being screened? It's a ridiculous statement to make based on statistics, not on human life.

    May 23, 2012 at 16:02 | Report abuse | Reply
  18. Shelton

    I am now 73 and when I was 70 my PSA test was high and the doctor suggested the wait and see approach. After one year it had risen and we did a biopsy and the Gleason score was 9. After 48 radiation treatments I am still on the hormone shot every six months. I thank the PSA test for helping find the cancer..

    May 23, 2012 at 16:22 | Report abuse | Reply
  19. fernace

    I find it ironic that this naysaying article is juxtaposed w/musician Charlie Wilson's story about survival due to Early Detection! For years we've been told to practice preventative medicine & that early detection is key to surviving Any cancer & now we're supposed to belive Less screening is better!? This sounds like the "study" results released about a decade ago, that claimed kids who drank fruitjuice had a greater likelyhood of becoming obese! It was paid for by a softdrink company! Preventative medicine is a lot less costly than treatment for a deadly or chronic illness & while that's a good thing for the individual, it may not be such good news to companies that make their living from chronic/fatal diseases! If it's mandatory, at a certain age, for a woman to have a mammogram, men should be also be screened for a cancer that is 1 of the deadliest for their gender! I guarantee that the family of a 70 year old man wants him to stick around as long as possible & he's in no way expendable as a statistic!!

    May 23, 2012 at 22:29 | Report abuse | Reply
  20. md

    The truth is we have nothing better than PSA testing for early detection. The majority of prostate cancer today is detected because the PSA was elevated and everything else was normal (prostate cancer can only be detected by a biopsy). Early detection means we have more time to decide on the proper course of action. Unfortunately, treatment for prostate cancer can and often does result in undesirable side effects. It is because of these side effects (particularly erectile dysfunction and urinary incontinence) that many factors should be considered before the proper course of action is decided. For some patients, watchful waiting is appropriate which means either following a patient for symptoms (i.e. bone pain, fractures, etc.) or possibly with regular PSA's but nothing else, usually reserved for older/unhealthy patients; active surveillance which means periodic testing of PSA and periodic biopsies in which we look for increasing PSA or more aggressive forms of cancer on subsequent biopsies to determine if treatment is necessary, this has become more popular over the last few years particularly with younger patients wanting to defer or avoid treatment due to fear of side effects; curative therapy for prostate cancer that has not spread (surgery, radiation); systemic therapy (usually for patients in which the cancer has already spread and is not curable). The problem with prostate cancer is that it is typically asymptomatic until it is advanced. Symptoms most commonly attributed to the prostate are usually due to benign enlargement of the prostate, NOT cancer. Unfortunately, if prostate cancer screening is abandoned, patients will present later and their options will be more limited. Just remember this, just because you have an elevated PSA doesn't meant you have to have a biopsy and just because you have prostate cancer doesn't mean you have to have treatment. All of these decisions should be between you and your doctor. As a patient, I want all of the information available to me so I can make an informed decision. As an urologist, I certainly feel we need to do a better job using PSA for what it is, an imperfect test, but I also don't want to throw away a tool just because it has limitations when there is nothing currently to replace it.

    May 24, 2012 at 00:09 | Report abuse | Reply
  21. plenty

    It is good to have a PSA or two to establish a baseline, then have one every two or three years.

    May 24, 2012 at 00:57 | Report abuse | Reply
  22. millenar1024

    Reblogged this on urologus.

    May 24, 2012 at 01:51 | Report abuse | Reply
  23. ilene

    I am a cancer survivor and I do not think most people or even most doctors understand the difficult side effects that people have from chemotherapy, radiation and surgery. I can not imagine anyone with 90% chance of survival without intervention undergoing treatments which not only have risks (including death) and terrible discomfort at the time but effect your health negatively for the rest of your life. I think that the task force is correct in trying to prevent unnecessary treatment, suffering and death. People are always free to have the test if they choose.

    May 24, 2012 at 11:18 | Report abuse | Reply
    • Alif

      Hi Daniel,Thanks for that voluntary ianormftion. I'm going to test drive this service by noting if any activities from Ethical Nutrients or mdBriefCase appear on the record. If so, I'm stoked! That means we can access any material requiring a PSA membership number, as long as its not published by the PSA themselves. Very handy.Thanks again,Leo

      September 11, 2012 at 12:45 | Report abuse |
  24. Richard Rivas

    How stupid to find as a solution to over-reaching treatment by some Doctors, not knowing if you have prostate cancer. That's is like the child who believes you can't see him if he covers his eyes- except that the consequences are UNDIAGNOSED CANCER! It may not be as easy to talk about as breast cancer and we aren't waving pink ribbons because of it, but men DIE of prostate cancer! I will wait about another 16 months before my recent treatment for prostate cancer can be diagnosed as successful. Today, I still have about a 10% chance that it was not completely successful in which case I will probably die prematurely of my cancer. Men, be informed. It IS a matter of life or death.

    May 24, 2012 at 15:35 | Report abuse | Reply
    • Natalia Kapsalis

      Remember that women were very embarrased to talk about breast cancer back in the day. But they fought back against their own feelings of impropriety because they knew that if they kept quiet people would lose their lives. Men need to find a way to remove the taboo from prostate cancer and talk talk talk to anyone who will listen. Ther is no shame in any of this. Give prostate cancer the FINGER!!!!

      June 5, 2012 at 09:41 | Report abuse |
  25. Pelvic Guru

    Reblogged this on Pelvic Guru and commented:
    Are PSA test for Prostate Cancer screening doing more harm than good?

    May 24, 2012 at 22:48 | Report abuse | Reply
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    May 26, 2012 at 00:53 | Report abuse | Reply
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    June 13, 2012 at 13:32 | Report abuse | Reply
  28. STEVE

    I google, google and google again. The answer regrettably is the same, the cancer cells will become resistant to the hormone therapy and I will die.
    My bad news came from my oncologists at Dana Farber/ Brigham & Womans two years ago at 52. Being the elephant in the room takes some getting accustom to along with the daily struggle of acting " normal " for the sake of my 2 beautiful daughters and my wife of 32 years.
    I spent most of my adult life protecting my family from pain.. Now causing my family mental pain over and over again is simply awful. Please visit our foundation,
    http://www.bedforfoundation.com

    July 9, 2012 at 10:22 | Report abuse | Reply
  29. Suraj

    Like Jim I too was diagnosed with Cancer of pattorse in my 70s and was put onto `Watchful Waiting` and told that I would not `die of it` but that I would `die with it.` I had to retire from nursing after completing 58yrs. but I refused to accept the `watchful waiting verdict` and, as Jim did, I became involved in research advances made in the treatment of cancer of the pattorse and found that a breakthrough had been made by a brilliant Urological Surgeon in Basingstoke and I contacted him and he offered to take me onto his trial despite my age . It had been long, inconvenient and uncomfortable for me as well as the expense of traveling to Basingstoke and staying overnight but after a year I am free of the curse of Cancer and have only one more review in the New Year and will have no need to attend further if I am still clear. Do not accept your GPs opinion on your condition. Search elsewhere and try to find where there has been an advance or breakthrough made and ask to be involved. GET A LIFE?? Cliff Charlesworth RGN. RMN. RNMH

    August 1, 2012 at 16:03 | Report abuse | Reply
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