But Barry believes the USPSTF recommendation is too black-and-white. "What I'm espousing is the middle of the road," Barry says. "I absolutely agree that many men look at that [the report] and say that's a really small benefit for the harm of potentially doubling my risk of getting prostate cancer and all the side effects of treatment that may come with it, but I think other men would look at the same data and say, 'For me, it's worth it.' So rather than solving it with a one-size-fits-all recommendation for everyone, I like doing it on the individual level."
Many other physicians have mixed reactions to the recommendations. In a survey of "Top Doctors" conducted by U.S. News and World Report, more than 60% of internal medicine specialists said they would continue testing despite the task force recommendation.
Barry acknowledges that many physicians have a "dubious" record of decision-making for PSA testing. "We have been ordering PSA tests without discussion. We have been ordering them in very old men without anything to gain," he says.
For primary care physicians, however, serious conversations about the issue have been compromised during regular office visits, wrote Allan S. Brett, MD, and Richard J. Ablin, PhD, also in last month's New England Journal of Medicine.
"The idea that physicians could initiate truly informed discussion was wishful thinking," Brett and Ablin write, "because clinicians and patients had to consider an enormous list of probability estimates and uncertainties."
"Patients were not really making informed decisions and office-based discussion of the pros and cons of PSA testing was essentially a charade," they add.
While the controversy continues over PSA testing, that charade must cease, as Barry sees it. Physicians must take the time—or at least provide patients the proper educational tools—to help men make an informed choice about PSA screening.