Local physicians question national recommendation for prostate-cancer screening
SALT LAKE CITY — Doctors with Intermountain Healthcare are countering national recommendations that say men should avoid a routine prostate-cancer screening test.
The prostate-specific antigen test, which screens a man's blood for signs of cancer, came under fire by the U.S. Preventive Services Task Force last week, after the group examined multiple studies on the popular test, finding that the risks outweigh the benefits.
"Prostate cancer is a serious health problem that affects thousands of men and their families. But before getting a PSA test, all men deserve to know what the science tells us about PSA screening: There is a very small potential benefit and significant potential harms," task force co-chairman Dr. Michael LeFevre said in a statement.
The group gave the test a D grade, meaning there is "at least moderate certainty that the harms of doing the intervention equal or outweigh the benefits in the target population." The recommendation may influence insurance coverage of the test.
Prostate cancer is the second-leading cause of cancer deaths in men and one in six can expect a diagnosis in their lifetime, according to the American Cancer Society. Nearly 28,000 will die from prostate cancer this year, but not all cases pose a risk to the patient. More than 25 percent of men in their 60s with the cancer are unaware that they even have it.
According to thousands surveyed in the U.S. and European studies, elevated levels detected by the test led to unnecessary biopsies. A biopsy can then lead to various medical complications, such as infection, pain, difficulty urinating or other medical issues. When a biopsy reveals any seemingly malignant cells, the majority of men opt for surgery, radiation or hormone-deprivation therapy, which each carry its own set of consequences, including cardiovascular problems, incontinence, impotence, erectile dysfunction or death.
Despite the risks, Dr. Jay Bishoff, director of the Intermountain Medical Center Urological Institute, said it would be a mistake to eliminate the test completely.
"While we agree the PSA is not a perfect test, our experience, supported by data, shows the test has reduced prostate cancer-specific deaths by 44 percent," he said. "The PSA can and does save lives."
The PSA test, which can detect cancer in its early stages, is typically recommended for men with an increased risk of the disease, between the ages of 40 and 75, but it is also routinely run on healthy men as well. New guidelines are causing a rift in the industry, as the task force now recommends against routine screening of men, regardless of age.
When used alone, Bishoff agrees, the test's value can be debatable. But when paired with other tools, the PSA test can be useful in identifying a man's risk of cancer, he said.
"At one hospital, a patient may have a PSA of 3.8 and his doctor may say he's fine," Bishoff said, adding that doctors at Intermountain would come up with a much more precise indication of risk. "So, for example, if the patient is African-American, has an abnormal rectal exam and is taking finasteride — a drug used to prevent prostate cancer — then his cancer risk is about 53 percent. That's critical information and we wouldn't have it without the PSA test. It is very likely that this patient will choose to have a biopsy."
In addition to the PSA test score, Intermountain physicians include in the tally a patient's body mass index score, race, family and genetic history, as well as other factors. The information helps provide a more accurate picture of the likelihood of prostate cancer, Bishoff said, adding that it also decreases the number of unnecessary biopsies performed at the hospital.
Regardless of the recommendation, the task force advises all patients to have an open discussion with their doctors prior to submitting to the PSA test.
The new recommendation doesn't preclude men from obtaining the test, but guides what insurance companies will reimburse on the more than $60 blood draw. The only other available cancer screening is the antiquated digital rectal exam, which cannot detect cancer in its early stages. Neither test can distinguish how far along the cancer is.
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