The U.S. Preventive Services Task Force now says that doctors should stop using the prostate-specific antigen, or PSA test, to screen men who have no symptoms. The reasoning is that there’s very little evidence widespread screening has actually lowered death rates.
But there is evidence that some men are undergoing unnecessary surgeries and losing urinary or sexual function.
“We know PSA is not a good test. We realize that. But it is the best we have.”
Dr. Steven Canfield directs the urology residency at UT-Health Medical School here in Houston. Canfield agrees that a positive test can put many men in a quandary.
The PSA is difficult to interpret.
And most prostate cancers are slow-growing. Many men will die from other causes before the cancer ever becomes a problem, if it does.
But Canfield disagrees that the test should be discontinued.
“So while screening itself is imperfect at this time, it doesn’t mean we should stop offering PSA to men. We should just be getting smarter about how to use PSA.”
The American Urological Association has not yet changed its recommendation that all men over 40 get a PSA screen.
Canfield says he fears that busy primary care doctors will use the new recommendation as an excuse to avoid a complicated discussion.
“So this is going to be an out. Now they can say 'Oh, fine. Good. We don’t have to do this test anymore. It’s useless.' And before we know it, we’ll be back to the time when men are presenting with metastatic prostate cancer again.”
If the recommendation becomes final, insurance companies may stop reimbursing for the PSA test.
From the KUHF Health Science and Technology Desk, I’m Carrie Feibel.