Last Update: Wednesday, August 20, 2014
|LIFELONG HEALTH- Use of PSA Blood Test Questioned by Task Force|
|Written by Dr. David Lipschitz Creative Syndicate|
|Thursday, 13 September 2012 02:35|
Conflicting opinions on cancer screening have caused a great deal of confusion for health care providers and the general public. This particularly applies to breast and prostate cancer screenings.
Most recently, the U.S. Preventive Services Task Force issued a definitive recommendation against using the PSA blood test to screen for prostate cancer in healthy men of any age. Even in those who are at a high risk for developing prostate cancer, including blacks and men with a strong family history of the disease, the value of the test is questioned. Their recommendation is primarily based on two facts:
First, the task force maintains that the PSA does not reduce deaths from prostate cancer.
Second, screening leads to needless biopsies (as many as one million annually) and unnecessary surgeries and radiation that frequently result in incontinence, erectile dysfunction and other urinary and bowel problems. Many patients receive hormonal therapy to decrease testosterone levels. This often causes fatigue, weakness, osteoporosis and a poor quality of life.
Many urologists and cancer experts strongly oppose the notion of completely abandoning the use of the PSA. They maintain that early detection does indeed save lives, and worry that failure to detect prostate cancer early will lead to a far greater number of patients who develop widespread disease throughout their body. Symptoms include severe bone pain and fractures, neurological issues due to spread of the tumor to the brain and many other problems.
Widely disseminated prostate cancer causes a great deal of suffering. Their point of view is strengthened by the fact that the task force recommendation was based on an American study that was seriously flawed with inaccurate conclusions.
Recently, an important research article was published in the New England Journal of Medicine that attempted to weigh the potential benefits of a PSA screening against the impaired quality of life as a consequence of further testing and treating prostate tumors.
In this stud, the PSA test was measured every four years in 1,000 men between the ages of 55 and 69.
Their analysis predicted that the PSA test would result in an increased number of prostate cancers diagnosed, from 112 to 157 cases. But the number of deaths from prostate cancer would decrease from 31 to 22 cases, and the number requiring end-of-life palliative care would decrease from 40 to 26.
In this study, screening healthy men led to a 37 percent reduction in mortality from prostate cancer.
Their research also demonstrated the downside of screening, including a marked increase in the number of biopsies.
And of the 104 cancers identified, a total of 45, or 43 percent, were over-diagnosed.
In other words, prostate cancer was diagnosed and treated despite compelling evidence that showed the tumor would never have caused symptoms or reduced life expectancy. Quality of life was also affected by the high risk of significant complications.
An editorial in the New England Journal of Medicine acknowledged that the PSA test saves lives but at a high cost.
The publication does not believe that definitive information is yet available to make a concrete recommendation either for or against PSA screening. Each patient should have a frank discussion with his physician before a screening decision is made.
Screening practices in America are very different from Europe. Here, annual testing is recommended. In contrast, in Sweden, men are screened every two years, and, in Holland, every four. Deaths from prostate cancer are the same in all three countries.
Annual screening leads to more unnecessary biopsies and more diagnoses that cause more harm than good. And in the United States, PSA tests are measured in men in their 80s despite the fact that there is no evidence that screenings are of any value in men over age 70.
The upper limit of the normal range for the PSA is 4. This is the level at which a referral to a urologist should be considered.
In medicine, nothing is ever clear-cut. As I am in my 70th year, I will no longer be screened. But at a younger age, testing should be considered if you fully understand the potential downsides of over treatment.
Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz visit www.drdavidhealth.com.
|Last Updated on Thursday, 13 September 2012 02:38|