PSA Screening Does A lot more Harm Than Good

Millions of guys are examined every year for high ranges of prostate-particular antigen, or PSA, which is designed to detect early indicators of prostate cancer. The test is covered by insurance, so most males readily agree to it. After all, what’s the harm?

Nicely, loads. PSA screening, we now know, “leads to a significant overdiagnosis of prostate tumors.” Many of these cancers increase extremely slowly, and males with slow-developing prostate tumors may possibly never ever have signs and symptoms. Nonetheless, as soon as a guy is advised he has cancer, there is a a sturdy tendency to deal with it, and therapy has severe, frequently damaging side effects: 20-30% of men taken care of with surgical procedure and radiation will have extended-phrase incontinence and erectile dysfunction.

There is a furious debate going on right now more than the proof for and towards PSA screening. The debate commenced with a large-scale US study called PLCO, which found no benefit from annual PSA screening. Soon following that, the US Preventive Companies Activity Force recommending that most males should not get standard PSA exams.  They concluded:

“Many more guys in a screened population will experience the harms of treatment than will encounter the benefit…. The USPSTF concludes that there is reasonable certainty that hte benefits of PSA-primarily based screening for prostate cancer do not outweigh the harms.”

The American Academy of Household Physicians agrees, and has adopted a clear recommendation:

“Don’t routinely screen for prostate cancer using a prostate-specific antigen (PSA) check or digital rectal examination.”

which I wrote about last November.

Blood test vials (Photo credit: tyfn)

In contrast, the American Urological Association responsed to the USPSTF report by issuing a statement that it was “outraged and believes that the Task Force is performing men a fantastic disservice.” Prostate surgical procedure is massive organization for urologists, which could have biased their reaction. Nevertheless, to their credit the AUA modified its tips on PSA screening, which now state

“The [AUA] Panel does not recommend program screening in guys in between ages 40 to 54 many years at common danger.”

For guys ages 55 to 69, they advise “shared choice-producing,” but they even now insist that there is a advantage for males in this group. Their 2013 press release says “the highest good quality evidence for screening benefit was in guys ages fifty five to 69 screened at two- to four-yr intervals.”

Why does the controversy continue? One reason is that a big European study, called ERSPC, reported a little benefit from PSA screening. The European study is actually a combined analysis of seven studies in seven countries, every of which was run a bit in a different way.  Five of the scientific studies reported no advantage, and just two, from Sweden and the Netherlands, showed a benefit.

So what was going on in these two nations? Did they do screening differently, or therapy in a different way? Nicely, it would seem they did. In a letter published in Uro Today on May possibly six, Ian Haines and George Miklos lay out an explanation: in the Swedish study, many a lot more sufferers in the control group (the group that did not get PSA screening) were handled with androgen deprivation therapy, ADT ADT, which latest proof indicates may improve the threat of death. Haines and Miklos published a much more comprehensive analysis last October, accompanied by an editorial by Otis Brawley, the Chief Health care Officer of the American Cancer Society American Cancer Society.

Brawley pointed out that

“the harms of screening have been persistently demonstrated in all screening trials to date.”

He calls for “an goal panel of specialists with accessibility to all of the data” to deal with the controversy above the attainable bias in some of the European trials. Carlsson et al. responded last month in the Journal of the Nationwide Cancer Institute, defending their methods, but Haines and Miklos fired back in the same situation, arguing that the advantages located in the European research “rests completely on the … Goteborg trial from a single city.

Regardlesss of the proof from that 1 city, even though, the evidence today is powerful that until finally we have significantly far better therapies for prostate cancer, regimen screening with PSA tests leads to much more harm than very good. The side effects of surgical procedure can be lifestyle-altering and devastating. Guys: unless of course you have a specific cause to be concerned about prostate cancer, tell your doctor “no thanks” if he gives you a PSA check at your next checkup. That’s what I did.

PSA Screening Does A lot more Harm Than Good