A urologist responds to the new prostate cancer screening guidelines

U.S. Panel Says No to Prostate Screening for Healthy Men” was the title of an article on the front page of the New York Times on October 6, 2011.  The article goes on to suggest that healthy men should no longer receive a PSA blood test to screen for prostate cancer because the test does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence in many, a key government health panel has decided.

Two years ago the very same task force recommended that women in their 40s should no longer get routine mammograms, setting off a firestorm of controversy. That recommendation was met with strong resistance by many cancer organizations, women and their doctors, many of whom continue to ignore it.  The recommendation to avoid the PSA test is even more forceful and applies to healthy men of all ages.

One in six men in the United States will eventually be found to have prostate cancer, making it the second most common form of cancer in men after skin cancer. An estimated 32,050 men died of prostate cancer last year and 217,730 men received the diagnosis. The disease is rare before age 50, and most deaths occur after age 75.

So what do Joe Torre, Bob Doyle, Jerry Lewis, John Kerry, General Norman Schwarzkopf, and Mayor Rudy Giuliani have to say about PSA testing?  All of these men have had PSA testing which led to the diagnosis of prostate cancer and have received successful treatment their disease.  These men are among tens of thousands of men who believe a P.S.A. test saved their lives.  Some of these men, which include Mayor Giuliani and Joe Torre are advocates for PSA testing and plan to fight the recommendation.

The PSA test, routinely given to men 50 and older, measures a protein — prostate-specific antigen — that is released by prostate cells, and there is little doubt that it helps identify the presence of cancerous cells in the prostate. But a vast majority of men with such cells never suffer ill effects because their cancer is usually slow-growing. Even for men who do have fast-growing cancer, the P.S.A. test may not save them since there is no proven benefit to earlier treatment of such invasive disease.

So what am I recommending for my patients and myself?

This report by a panel of experts (the chairperson is a pediatrician and probably has never seen or diagnosed a patient with prostate cancer) is certain to cause confusion and anxiety among men and their doctors, and reignites a debate about the benefits and risks of screening tests.

The recommendations affect more than 44 million men age 50 and older who typically are candidates for the PSA test.

Whether to be screened for prostate cancer is still a decision that each man must make for himself with the advice of a doctor he trusts, usually the man’s primary care physician or a urologist.

The panel’s advice is based on studies of healthy men. Men who have symptoms related to prostate health such as painful urination or blood in the urine should seek out medical care from their doctor. Also men with a strong family history of prostate cancer may have more to gain from screening than men at low risk, so they also should discuss the issue with their physician.

Finally, my advice to a man who already has a diagnosis of prostate cancer and has chosen to follow a course of watchful waiting should continue to undergo PSA testing, which can help doctors determine whether cancer has returned or is spreading.

I recommend to my patients that they begin testing on an annual basis after age fifty.  However, if they have a close family relative, father, brother, or uncle with prostate cancer, that they begin testing at age 40.  Also, African-American men should also begin PSA testing at age 40 because of the increased risk of prostate cancer among African-American men.  I do not recommend PSA testing in men with less than 10 years life expectancy.

The PSA test is a non-invasive, inexpensive test that is helpful in detecting early prostate cancer.  Each man should have a discussion with his doctor and determine if PSA testing, diagnosis and treatment is right for them.

Neil Baum is a urologist at Touro Infirmary and author of Marketing Your Clinical Practices: Ethically, Effectively, Economically. He can be reached at his self-titled site, Neil Baum, MDor on Facebook and Twitter.

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