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.
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://