PSA Testing: More Harm than Benefit?

The bad news for prostate cancer screening advocates began last summer when the United States Preventive Task Force (USPSTF) gave the PSA test a grade of “D,” stating that the risks inherent in PSA screening outweigh the benefits.

consumer_reportsThe March 2013 issue of Consumer Reports (CR) deals a fresh blow to prostate cancer advocates who promote PSA testing as a means of detecting the disease in its early rather than advanced stages.

The magazine’s cover announces in giant font, “Save Your Life.”  In only slightly smaller type: “3 cancer tests you need plus 8 you don’t.”  The three screening tests you need: colon, cervical and breast.  (Which leaves just one test for us men.)  One of the eight you don’t need is for prostate cancer.  CR‘s rating in answer to the question, “do the benefits of the [PSA] test outweigh the harms?” is “very unlikely.”

The article* dramatizes its argument by leading off with a half-page photograph of a doctor who “says he developed a life-threatening infection after a biopsy prompted by prostate cancer screening.”  In its early paragraphs, we learn that “Zero, the non-profit group that offers free prostate cancer screening at events around the country, counts among its partners doctors and businesses that can benefit financially from cancer testing and treatment.”  Implication: non-profit advocacy organizations are the innocent-looking front for profit-seeking medical organizations and big pharma.

The USPSTF, on the other hand, is lauded as “working to provide more nuanced, accurate information on cancer-screening tests.” There is no mention of what that more nuanced, accurate information might look like or when we might see it.

The article concludes with a quote by Virginia Moyer, a member of the USPSTF, stating, “scientific evidence shows that some cancer-screening tests work, and people should focus on those tests rather than on screening tests that are only supported by theories and wishful thinking.”  It’s not too difficult to deduce in which category she places prostate cancer screening.

What the article does not discuss is that significant progress is being made on screening tests that will be able to distinguish between indolent and aggressive disease.  There’s no discussion of active surveillance after diagnosis, or that 20 to 25 percent of prostate cancer diagnoses are of aggressive disease.  And certainly no mention that the National Cancer Institute estimates that 29,720 men will die of prostate cancer in 2013—up 5 percent from its 2012 estimate.

As others have said, the PSA test is certainly imperfect, but it is not fatally flawed.  But CR‘s clear message is that the blood test can lead to dangerous biopsies, and it does not allow for the fact that a rising PSA might prompt a man to have an intelligent conversation with their doctor about what, if anything, to do next.

Instead, a male reader is left with the conclusion that PSA testing will cause more harm than benefit.  So, unless you’re in a well-known risk category (family history, African-American), it’s better to do nothing at all, particularly if you’re under 50 or over 75.

Consumer Reports may be well qualified to assess automobiles and TV sets, but in simply announcing to its substantial–and trusting–readership that more harm than benefit will come from a PSA test, without telling men that a conversation with their doctors about prostate cancer might be a useful first step, borders on shabby journalism.  Especially for the more than 238,000 men in 2013 who will hear the words, “You have prostate cancer.”

What impact do you feel this article in Consumer Reports might have on screening for prostate cancer?  Should advocacy organizations such as Zero respond to the article?  If so, how, without seeming defensive?

*The article may be previewed at http://www.consumerreports.org/cro/cancer0313.htm You must be a subscriber or buy a copy of the February 2013 issue to read the entire article.

Comments

  1. John S. says

    I agree with your judgement of the article. I would add irresponsible to “shabby journalism”. The USPSTF did a large disservice to men when grading the PSA test with a D rating. Diagnosed at age 48, with agressive, but not yet advanced prostate cancer, please explain to me how testing for prostate cancer did me more harm than good. I’m glad to have that discussion with anyone. At least it won’t be a discussion with my children as to why I was not proactive and no longer here.

  2. John says

    I believe that their interjection into healthcare decisions is completely irresponsible. I was diagnosed with late stage 2 prostate cancer at age 45. After research, many appointment s and prayers, I opted to have it removed via da Vinci procedure. Four years later, I am cancer free and dealing with minimal effects from the surgery. Count me as a former CU subscriber.

  3. Edward Wakeley says

    Excellent Article Craig. Thank you for taking a lead on this. These are the types of articles we as prostate cancer patients and survivors must fight against to get the word out to men to get tested, get the best information available to make the decisions that are best for them. I was diagnosd at 50 and had a prostatctomy, With a Gleason of 6, most would consider that low grade, however when my prostate was removed it was full of “low grade cancer”, 7 seperate tumors. now 18 months later my psa is rising a little at each 3 month check up. While I have radically changed my diet and my exercise routine, I am hoping the rise is an anomoly. Radiation could be in my future? You will never convince me that PSA testing is harmful and that I would have been better off not knowing I had prostate cancer. There’s no good cancer, there is no type of cancer to get if you are going to get cancer. Its life changing and possibly life ending.

  4. Frank Washburn says

    I have been checking my PSA and prostate since I was 50 yo now 59 and after seeing the PSA rise a biopsy was taken and I was diagnosed as Pre Pin…..ie. a cancer suspect…. so each year had PSA done and it rose over time…then in April 2012 another biopsy..and one core was 15% cancer…and told could be aggessive. So what to do….watch? Oncology? or remove….. after 3 Dr visits I decided for removal manly because of the potential to be an aggressive cancer. And absolutely no regrets for my decision………… the PSA checks and biopsys lead me to my decision…………….

  5. Greg Hoffman says

    Well Craig, here we are again, defending our need for accurate, timely and professionally appropriate testing. The result of the article is yet another ill-thought out diatribe of sweeping, generalized statements that will cause more men to ignore, then regret annual PSA testing. My annual physical allowed for a baseline PSA. My 2010 PSA showed a doubling count from the previous year. The DRE indicated a bumpy surface where a smooth surface is expected. Alarmed at this, my PCP strongly recommended a visit with a urologist. The results of that visit and follow-on ultrasound and a 12 core biopsy revealed Gleason 7 to 9 in all but one of the cores. My diagnosed aggressive and fast moving prostate cancer went from stage II to stage IV by the time I was on the table for DiVinci procedure a mere 2 months later. Cancer had spread from the prostate to the seminal vesicles and the lymph nodes. Radiation and Androgen Deprivation Therapy (Lupron) has given me hope for long term remission. The side effects are frustrating and at times interfere with daily activities. But I get up every morning, grateful that an educated and caring personal physician was the beginning of a journey of detection, treatment and a continued life of fulfillment for me and my family. Don’t stop raising the flag of concern for misleading articles like this, Craig. You are providing a great service to men and their families.

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