By JIM STOMMEN, Medical Device Daily Contributing Writer
The arguments going on these days over the prostate cancer screening test known as prostate-specific antigen (PSA for short) might make one think that there’s something wrong with the test itself.
Not so. The argument by what we will refer to as the “anti” side of the issue is with what happens after the routine blood test comes back with a positive finding. Those folks, who go by the name U.S. Preventive Services Task Force, maintain that the PSA test leads to demonstrative levels of over-treatment, doing so to such an extent as to outweigh any benefits gained by early detection of the second-most-common cancer in American men.
The task force maintains, in essence, that routine PSA testing does more harm than good. They point to “needless” biopsies, the potential for infection as a result of such biopsies, and various and sundry other things to fear as a positive finding leads to surgery and other forms of treatment.
Personally, I think the folks who make up the task force are missing the point, which I believe is as simply as early detection is better than no detection. In the case of cancer in any form, ignorance definitely is not bliss.
An Atlanta-based urologist put it pretty concisely in a story on the controversy that ran in the Atlanta Journal-Constitution. “Early detection is critical to the success of prostate cancer treatment,” said Mark Haber, MD, managing partner of Georgia Urology. And the PSA test, which measures the levels of prostate-specific antigen, a protein released by prostate cells, is the most commonly used tool for such early detection.
The U.S. Preventive Services Task Force’s viewpoint brings to mind the recommendation made by a privately-based group of caregivers a couple of years ago that routine mammograms no longer were deemed necessary for women in their 40s, pegging 50 as a better starting date for such imaging studies.
I didn’t see their reasoning as making an awful lot of sense then, and still don’t, so my reaction to the thoughts on PSA testing may be tinged by the head-shaking I did over that one.
But I digress. Part of the argument against PSAs is that prostate cancer is so slow to develop. It used to be said (might still be, although I can’t recall having heard it said lately) that many more men die with prostate cancer than of prostate cancer. Because prostate cancer is slow-moving, it is not seen as being as urgent a matter as other forms of the disease.
For the life of me, I don’t understand how not knowing about the possible presence of the disease as early as humanly possible lessens the impact once it is confirmed that one is indeed suffering from it. Yes, incontinence and impotence are proven side effects once treatment begins, but getting to that point is quite a ways down the road after a PSA test indicates the potential for such a diagnosis.
Virginia Moyer, who chaired the task force that came up with the “no PSA” recommendation, indicated that one of the reasons for that approach – or non-approach, as the case may be – is that once patients learn they have prostate cancer, they demand aggressive action in the form of biopsies and, if confirmed by biopsy, in the further form of surgical or radiation-based treatments whether needed or not.
So the task force’s solution is to shut down the primary channel of early information, a test that after two decades of existence is routine for men over 50, and sometimes over 40. Oh, they’re not trying to eliminate PSA testing entirely, just to make it no longer a matter of routine, administered only when warranted by risk factors and symptoms.
Marc Siegel, MD, of NYU Langone Medical Center in New York, said in a commentary for USA Today that the recommendation angers him. “As a practicing internist, I need all the help I can get in diagnosing the many diseases that threaten the life and well-being of my patients," he wrote. "The PSA test . . . is by far the best tool I have for detecting this dreaded disease. A high PSA reading is a clear red flag.”
He went on to say that because prostate cancer is “almost always asymptomatic at first, the PSA . . . is my best way to find it.” As for the risk of overly aggressive treatment being spurred by such tests, Siegel essentially said good doctors know better and base their treatment on sound decision-making between physician and patient.
While other prostate screening tests are in the works, some of them proteomics-based, he said that for now, PSA is what doctors have in the way of tools for early detection, “and we would be fools not to use it.”
Amen to that. I have the test done annually, and certainly will continue doing so.
(Jim Stommen, retired executive editor of Medical Device Daily, is a freelance writer focusing on healthcare issues.)