The U.S. Preventive Services Task Force recently released new recommendations regarding the use of prostate-specific antigen (PSA)-based screening for prostate cancer. As of May 22, the USPSTF now recommends against PSA screening for prostate cancer, stating “there is a very small potential benefit and significant potential harms.” The new USPSTF recommendation has unleashed controversy in the medical community.
Prostate cancer is the most common cancer in men, and is a leading cause of cancer deaths, second only behind lung cancer. In 2011, more than 33,000 men are estimated to have died directly as a result of prostate cancer. In that same year, however, more than 240,000 men were newly diagnosed with prostate cancer as well.
The incidence of diagnosing prostate cancer has steadily risen since the introduction of routine PSA screening in men older than 50. The routine use of offering PSA screening began in the late 1980s, when the incidence of prostate cancer diagnosis was fewer than 100 per 100,000 men.
During this same period when PSA screening became more common practice in the United States, the rate of death from prostate cancer declined 30 percent. The natural assumption, therefore, is that PSA screening identified prostate cancers at earlier stages in men who never had any signs or symptoms of the disease. By identifying the cancer at an earlier stage, treatment resulted in fewer deaths from prostate cancer.
Thousands upon thousands of men will undergo invasive treatments for their newly diagnosed prostate cancer, such as prostatectomy, radiation therapy and hormonal treatments in an effort to eradicate their prostate cancer.
Every treatment modality for prostate cancer is associated with a variety of potential side effects, including incontinence and erectile dysfunction. The detractors of PSA-based screening argue that too many men undergo unnecessary treatment and suffer unnecessary complications for a cancer that potentially may never cause a problem to the patient if left undiagnosed and untreated.
The American Urological Association forcefully disputes the USPSTF recommendations. The AUA has characterized the USPSTF recommendation as “inappropriate and irresponsible,” and added, “Men who are in good health and have more than a 10- to 15-year life expectancy should have the choice to be tested and not discouraged from doing so.”
The panel that formulated the recommendation did not include an urologist.
The controversy is drumming up concern that Medicare will act on the USPSTF recommendation and stop paying for the PSA screening test, and private insurers would follow.
The fear stems from the fact that treatment of prostate cancer puts a burden on an already struggling health care system. In 2006, $9.862 billion was spent on treating men diagnosed with prostate cancer. The new USPSTF recommendation “could cause Medicare, Medicaid and private insurers to choose not to cover the PSA test and could take away an important medical choice of tens of thousands of men. ,” said Congressman Jon Runyan (R-N.J.), co-chairman of the Prostate Cancer Task Force.
The Obama administration has indicated Medicare will continue to pay for PSA-based screening, for now.
Many physicians likely will not change their clinical practice of medicine based on the new USPSTF recommendations against PSA screening.
Since 2008, the USPSTF has recommended against PSA screening for men older than 75. In a survey of men older than 75 in 2006, 60 percent said they had a PSA test in the past year. The result was identical for the men who were surveyed in 2010.
“The problem with prostate cancer is not finding the cancer but in knowing when to treat and when not to treat,” said Dr. Leonard L. Gunderson, chairman of the American Society for Radiation Oncology.
“The USPSTF is correct in addressing the issue of over screening but is wrong to take the option completely off the table.”
The decision to screen should take into account a variety of factors including a patient’s age, medical history and family history. Your physician is best equipped to analyze your risk factors.
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Dr. Anil A. Dhople, a native of Satellite Beach, has a biomedical engineering degree from Johns Hopkins University and medical degree from University of Florida. He completed his residency in radiation oncology at the University of Maryland, and is board certified. Before joining MIMA Cancer Center, he served as assistant professor in the Department of Radiology Oncology at the University of Maryland where he treated patients, participated in numerous clinical trials, and educated residents and medical students. Call 321-409-1956, ext. 7718.