Government Panel Recommends Against PSA Testing

The U.S. Preventive Services Task Force, which advises the government on health prevention measures, on Friday downgraded its recommendation on prostate cancer screening to a "D," which means it recommends against the service because "there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits." (Reuters News Service)

I am really struggling to understand this recommendation, particularly in light of my own experience with prostate specific antigen (PSA) testing and prostate cancer. I believe PSA testing can save lives. According to one source, prostate cancer is the second leading cause of cancer deaths in the United States. I have previously blogged about my experience with prostate cancer but include similar information in this blog to argue in favor of the PSA test.

We have a family history of cancer so I felt the PSA tests were important for me. I had an annual PSA test since my early 50s as part of my annual physical. The result was always in the normal range.

At age 59 my PSA increased about 50%. I had just completed antibiotic treatment for prostatitis. My primary care physician thought the prostatitis was the likely cause of the rise in PSA. She suggested retesting in six months. My urologist agreed that prostatitis may have caused the rise in PSA but felt six months was too long to wait. He ordered another PSA at three months. My PSA was up another 30% but still in a normal range at 3.9.

The rising PSA concerned my urologist and he suggested a biopsy. After some discussion and consideration, I agreed to have the biopsy. 12 cores were taken in a painful but short procedure. Only one core contained cancer. The Gleason score for the cancer was 4+3. This early stage cancer was located only in the right prostate lobe.

My urologist recommended radical prostatectomy (RP). He said that I was in no risk of dying soon. He explained that prostate cancer is usually slow growing but the Gleason score of 4+3 indicated my cancer was aggressive and would be likely to spread outside of the prostate if not treated. The prostatectomy was recommended to improve my outlook ten years and more in the future. Had I been 10 or 15 years older, the doctor’s treatment recommendation may have been different. There may have been no treatment at all.

I started researching options. The available literature was all over the place regarding appropriate treatment. I met with two other urologists, radiation and medical oncologists, and other members of a multi-disciplinary cancer team. All of them recommended RP. I eventually decided to have RP but waited for seven months due to other health concerns.

I had da Vinci robotic assisted RP in July 2011. The post-operation pathology report indicated the cancer was contained in the prostate. None was found in the lymph glands or surrounding tissue. However, the cancer tumor had spread to the left prostate lobe. 10% of my prostate was cancerous. This indicated an aggressive cancer growth.

I have every reason to be grateful for early detection and treatment of my prostate cancer. No one knows how long would it have taken for the cancer to spread outside of my prostate. If it had spread outside the prostate, treatment would have been much more difficult and prolonged. If I hadn't had PSA testing, the cancer may have gone undetected until it was too late to effectively treat it.

I’m still recovering from surgery. I have slight urinary incontinence and wear a pad for protection. I also have erectile dysfunction (ED). Hopefully both of these side effects of RP will clear up over time. Even if they don’t, I have no regrets about choosing RP to treat my cancer.

It is apparent from the available literature and studies that opinions of the effectiveness of PSA tests in detecting prostate cancer is questionable. In my opinion, a single PSA test cannot form the basis of a cancer diagnosis. However, establishing a baseline and following up regularly can be beneficial when PSA results are used in conjunction with other diagnostic tools. It makes no sense to toss the test when there is no better test yet available. We need to press for increased research and improved testing procedures.

In the meantime, allow doctors and patients to use existing tools appropriately. Encourage men to get a PSA Screening. It can save lives!

See the full panel recommendation at http://www.uspreventiveservicestaskforce.org/uspstf12/prostate/draftrecprostate.htm