Skip to main content

Urologists 'Outraged' Over PSA Test Challenge

 |  By John Commins  
   May 24, 2012

The nation's leading urology associations are fuming over a federal panel's report this week that discredits the widely used prostate-specific antigen screening test for prostate cancer.

The U.S. Preventive Services Task Force said in a report that the PSA test is too inaccurate, creates needless anxiety for patients, and can lead to costly and potentially harmful follow-up procedures.

"The USPSTF concludes that there is moderate certainty that the benefits of PSA-based screening for prostate cancer do not outweigh the harm," the report stated.

Major urology associations knew in advance about the USPSTF recommendation and urologists launched a counterattack when the report was made public this week.

"It's an absurd recommendation. It is ill-researched and ill-conceived," Sanford J. Siegel, MD, a board member with the Large Urology Group Practice Association, told HealthLeaders Media. "This will only do damage to all the great work that has been done for prostate cancer awareness and to control the deaths from prostate cancer."

American Urological Association President Sushil S. Lacy, MD, said in prepared remarks that he was "outraged" by the report. "It is inappropriate and irresponsible to issue a blanket statement against PSA testing, particularly for at-risk populations such as African-American men," Lacy said. "Men who are in good health and have more than 10-15 years life expectancy should have the choice to be tested and not discouraged from doing so."

A similar statement was issued this week by the American Association of Clinical Urologists, which called the USPSTF recommendations "misleading and harmful." The major urological associations say the USPSTF ignored new studies supporting the value of PSA tests, and that the panel refused to address concerns they raised about the conclusions during the comment period. In addition, the urologists complain that there were no urologists or oncologists on the panel.  

Siegel, who is also the president and CEO of Maryland-based Chesapeake Urology Associates, says urologists have long understood that the PSA test can lead to a high percentage of false positives, but he said that doesn't mean the test should be discounted.

"It is just a screening test, one of several things we look at when we decide whether a man needs a biopsy or not," he says.

 

Siegel concedes that PSA testing could lead to needless and costly procedures performed out of fear or caution.

"There is no question that men get prostate biopsies that obviously in hindsight shouldn't happen.  But we are looking at improving PSA testing and other testing to help us find out which men will progress with more advanced prostate cancer," he said.

The problem, he says, is that no one has yet come up with an alternative to determine which patients will develop advanced prostate cancer.

"Yes, it is true that many men can live with this disease their whole life. That is why active surveillance has become a treatment option," he says. "If we knew in advance who would and who wouldn't advance in the cancer, that'd be great!"

USPSTF said it could find no evidence to support claims that PSA tests are responsible for "reduction in all-cause mortality."

"In contrast, the harms associated with the diagnosis and treatment of screen-detected cancer are common, occur early, often persist, and include a small but real risk for premature death," the report said. "Many more men in a screened population will experience the harms of screening and treatment of screen-detected disease than will experience the benefit."

The report said that over-diagnosis and overtreatment becomes an "inevitability" with PSA testing, which "means that many men will experience the adverse effects of diagnosis and treatment of a disease that would have remained asymptomatic throughout their lives. Assessing the balance of benefits and harms requires weighing a moderate to high probability of early and persistent harm from treatment against the very low probability of preventing a death from prostate cancer in the long term," the report said.

Siegel said the report ignores or fails to explain the dramatic decrease in deaths from prostate cancer over the last several decades.

"About 250,000 men are diagnosed with prostate cancer each year. That has stayed pretty stable. It is the death rates that have come down significantly," he says.

"In the last 30 years the deaths have dropped from 48,000 to 28,000 a year. The surgery is better. The radiation is somewhat better. But there haven't been significant advances except in some of the surgical techniques to explain this, other than screening."

Siegel says he is concerned about "the greatest damage" the report will have on prostate screenings for African-American men, who are disproportionately affected by prostate cancer.

"I have been a urologist for almost 30 years. When I started training, 40% of African-American men at that time presented with metastatic disease. Now that number is miniscule," Siegel says. "Tell me how that happens without early screening? How do death rates go down from 48,000 when I trained to 28,000 now? How do you explain that without screening? You can't! It's impossible!"

Even though the test is being discouraged by the task force, Siegel says he believes many men and their physicians will want to keep the option on the table.

"If I am with a patient, I'm going to tell them 'we have a blood test to help diagnose prostate cancer. Yes, there are false positives. But if you have prostate cancer, do you want to know or do you want to play Russian roulette?'" he says. "Of course, I wouldn't say it like that. But that is the question. Who's going to say no?"  

Pages

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

Tagged Under:


Get the latest on healthcare leadership in your inbox.