Panel's Pitch to Nix Routine Prostate Cancer Tests Draws Strong Reaction

JEFFREY BROWN: Men shouldn't be routinely tested for prostate cancer. That was the recommendation today of an influential government panel that looked at whether PSA tests can extend lives by detecting cancer earlier.

The tests measure levels of a protein made in the prostate. But the U.S. Preventive Services Task Force said they do more harm than good, including unnecessary biopsies, surgery, radiation and impotence. The panel concluded that -- quote -- "The common perception that early detection prolongs lives is not supported by the scientific evidence."

Last year, more than 217,000 American men were diagnosed with prostate cancer; 32,000 died from it. And the recommendations are being met with both support and anger.

Overall, when they have taken a hard look at the scientific evidence, what the panel is saying is they concluded that there's no overall benefit compared to the risks that men face if they're told to undergo routine PSA testing. These are -- if healthy men are told go in and just get a PSA test on a regular basis to see if you have prostate cancer.

JEFFREY BROWN: And just to back up, that is the current standard practice now?

The way it works right now is once a guy hits about 50, his doctor usually starts recommending that he get a blood test, which is PSA test, to look for any signs that he might have prostate cancer. And then he pretty much gets it on a routine basis every time if he goes in for a routine physical or a routine checkup.

JEFFREY BROWN: All right, so fill in this picture about the risks, risks that outweigh any possible benefits. What are we talking about?

ROB STEIN: Yes. What they're talking about is, when somebody comes back with a positive PSA test, something that indicates that he might have prostate cancer, it starts sort of a cascade of medical treatments that can lead to some pretty serious complications.

At first, you start off with a biopsy to see if the guy actually has prostate cancer, and that's usually not that big a deal to go through and pretty safe. But in some cases, there can be complications and it can take some time to recover from even that. And then it turns out that -- if he has prostate cancer, then he has to undergo surgery or radiation. And that can have some very serious complications, the biggest ones being impotence and incontinence.

JEFFREY BROWN: Now, it's important to say that this panel -- these recommendations are for men who do not have any symptoms, correct?

This is for men who basically are healthy, there's no sign that they might have prostate cancer, there's no reason to think that they might have a tumor that nobody has picked up yet. It they're -- for men who do have signs, for men who there are indications they have prostate cancer, they should be going in and getting tested.

But this is -- this is for the general, sort of routine, "don't even think about it" recommendation that you just go out and get a PSA test on a regular basis without even -- maybe even knowing you had the test done.

JEFFREY BROWN: And when -- one of the issues here I guess is that prostate cancer develops very slowly, right?

ROB STEIN: Yes. No, that is -- that's a very important point is that prostate cancer, it's a very common cancer, but in a lot of men, they don't even know they have it, and if they never were tested for it, they might never find out that they had it. It grows so slowly, that they would end up dying of something else.

And so that's the big problem with prostate cancer, is right now we can't identify which men need treatment and which men don't. So if you go in, you get a test, you find out you have prostate cancer, pretty much most people are going to get treated. And that could lead to all sorts of complications that could even cause deaths, that could outweigh the benefits of the routine PSA testing.

JEFFREY BROWN: Now, everything here, all this, the PSA testing, has been debated for a long time. It's been quite controversial. And now these new recommendations are extremely controversial, I gather.

You have to remember this is the same panel that in 2009 caused a firestorm when they raised questions about routine mammography for breast cancer for younger women. And we're starting to see some of the same reactions to this. There's a large cadre of doctors and patients and patient advocacy groups who think that PSA testing is extremely important and saving lots of lives, and anything that raises any questions about it is going to cost a lot of lives.

JEFFREY BROWN: Well, so how influential is a panel like this? What -- where do you look at for impacts here for -- among doctors, among insurance groups and so on?

ROB STEIN: This is a very influential panel. And that's why people -- the reaction is so strong.

You know, this panel can't make anything happen, but doctors, you know, look to this panel to, you know, decide what advice to give their patients. Insurance companies look at what the panel recommends to decide what they should pay for. And, in fact, under the health care, the federal health care reform legislation that passed, this panel has actually become more influential, because some of the basic benefits that the federal government will require under the health reform legislation will be influenced by this panel's recommendations.

JEFFREY BROWN: So, briefly, Rob, what happens next? Is this a period of confusion for the medical community and men in general? Or what are you looking at?

ROB STEIN: Yes, it's important to note that, at this point, this is a proposal. So the panel is proposing changing its recommendations. They're proposing downgrading their recommendation for PSA testing to recommend not getting routine testing.

It will be open now for a period of time for public comment. This is one of the changes that the panel implemented after the uproar over the mammography recommendations, so the public has a chance to say what they think about it, and the panel will take a look at those comments and decide what to do for their final recommendations.

The PSA test is not costly. It’s usually included in a yearly blood test by your physician with an annual check up. What is important is the annual test since the real issue isn’t so much the number but the “velocity” with which it is changing. There seems to be some question as to where one should have a biopsy (most say 4 is the cutoff). In my case the number went to 4.6 and I had a biopsy that was negative. Now two years later the number has retreated to around 3. Interestingly when the accompanying DRE is administered ( my former Dr. did it before the PSA test which can affect the PSA result negatively and probably caused the number to be high. Also there is the issue of abstaining from sexual activity before a PSA test because that can adversely affect the PSA number. At least, if we are going to have the test, doctors should do it in the proper manner. I would probably not have had an elevated PSA and had to go through the biopsy procedure if Dr. Moron had done it correctly.

Way to go Fred! The idea subscribed to here by a couple of posters is that “if we want this test we should pay for it ourselves!” Huh? I pay for a health insurance supplement to Medicare as well as Medicare itself ( it isn’t “free, it is taken out of your Social Security). They encourage me to have this test! As someone pointed out it’s not a bank breaker and it is a decent screening tool. I have a relative who is probably alive today thanks to the PSA test. When his PSA went to 50, it still took several biopsies to actually find the cancer, but it WAS there.

Yes. What they're talking about is, when somebody comes back with a positive PSA test, something that indicates that he might have prostate cancer, it starts sort of a cascade of medical treatments that can lead to some pretty serious complications.

I see a lot of ignorance in this conversation. First there is the absolute value of the PSA; it could be less than 1.0 or 4.6. The rate of change and the percentage increase are important factors. Then there is the retest of the PSA making sure that the patient has not had sex recently or experienced a DRE to temporarily elevate the PSA.

Combine that with a DRE to determine whether or not to recommend a biopsy. Generally a PSA greater than 4.0 will get you a recommendation by your general practitioner to see a urologist.

The PSA saves many lives by early detection of prostate cancer, especially those that are not detectable by a digital rectal exam (DRE). Prostate cancer is a leading killer of men. The PSA is an important factor in early detection, and monitoring of prostate cancer after treatment.

great post - I think one of the problems that is not mentioned is that any guy with a “positive” PSA who does not get a major series of tests would then become a potential law suit for the MD...”why didn’t you treat my Dad, husband, or biggest benefactor.” Only malpractice reform will stop the aggresive actions of doctors to protect themselves.

My primary care Dr. had already dropped routine PSA testing. He also says that DRE does not elevate PSA.; very confusing, because the last urologist I saw said it did. I really would like to see them drop the DRE also. I could do without that. And what about routine colonoscopies, which cost far more than prostate tests?

JEFFREY BROWN: Now, it's important to say that this
panel -- these recommendations are for men who do not have
any symptoms, correct?

ROB STEIN: Right. And that is very important.

This is for men who basically are healthy, there's no sign
that they might have prostate cancer, there's no reason to
think that they might have a tumor that nobody has picked
up yet."


Rob Stein's statements are so blatantly false.

I was diagnosed with prostate cancer last year.  I was
healthy and had absolutely no symptoms.  There was no
indication of anything when the DRE was done.  My PSA was
8.2 so I had a biopsy.  The pathology report came back with
a Gleason 4+4=8.  This is considered high risk.  Again I
had NO SYMPTOMS whatsoever.

I had radiation teatments, both external beam and seed
implants.  My PSA reading has been on a steady downward
march since treatments. 

If every so called healthy man waited until some symptoms
showed up before getting tested we'd have a lot more deaths
from prostate cancer.

My advice - GO GET TESTED.

Good way to get rid of old white guys. Good central planning.

Black men are more likely than white men to die of prostate cancer, and the black men in this study reported knowing that they were at increased risk for prostate cancer before diagnosis.

The veteran described in comment# 1 was black.

They are talking about a screening test. These patients don't have any complaints.

You treat the patient, not the number. I'd repeat the test before sending a guy to the urologist.

Prostate cancer screening: Should you get a PSA test? Mayo Clinic ataff

Rise in PSA protein 'not prostate cancer sign'

UK men can request PSA tests, although there is no screening programme.

These guys are not the Independent Physician Advisory Board, and they've been around for a while.

Surveys show that many doctors and patients still believe in the power of the annual exam. But back in 1995, the U.S. Preventive Services Task Force, an expert panel convened by the Agency for Healthcare Research and Quality, rejected the idea that the standard annual physical exam is an effective tool for improving the health of patients. What the panel did say was that the content and frequency of periodic health exams needed to be “tailored to the age, health risks, and preferences of each patient.”

A patient could get a biopsy, be told the biopsy was positive for prostate cancer and that the plan was watchful waiting. My best friend had a negative biopsy. He still rants about the procedure. It was painful, and his prostate became infected.

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FReepmail me if you want on or off my health and science ping list.

What the stents really do is make it way more likely that You’ll have a stroke. They are collection points for plaque, and for bacterial inflammation.

You should be heavily on capsicum, and off of all polyunsaturated oils, and man made fats like margarine. Learn to like coconut oil; its the best route.

Stop worrying about the death panels, and learn how to take care of yourself.

http://www.doctoryourself.com/

http://thehealthadvantage.com/index.html

http://www.cancertutor.com/Hypertension/Hypertension.html

Black men are more likely than white men to die of prostate cancer

They are also less likely to get PSA tests. So I'll stick to my statement that they are targeting white men.

Knew a guy that was asymptomatic, no indication on digital, but who got an early diagnosis of an aggressive cancer from his PSA scores. These folks would prefer him dead. After all, early deaths are good for social security.

One - Disregard all advice from most all Doctors!

Two - Only get exams when symptoms require it.

Three - Doctors are mostly looking for revenue, that means that they will order tests that you not only NOT need but are not necessary.

Four - Read up on all things about your heath on the Internet.

Five - Ask about costs! Only you can prevent cost expansion because you failed to see if it was necessary.

Six - Never go to Hospitals unless it is absolutely necessary (life and death). Otherwise, you risk catching diseases worse that you went in for!

Seven - Never take an ambulance if you can avoid it.

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