What did the USPSTF review find?
The task force focused on five clinical trials, including two large studies from the U.S. and Europe. The American study included more than 76,000 men and the European trial involved 182,000 men from seven countries; both trials compared outcomes in men who received routine PSA tests and those who did not. Overall, during a decade of follow-up, the data showed that there was no reduction in death rates from prostate cancer in men who got screened versus those who didn’t. In the European study, however, there was a slight benefit in mortality among men aged 55 to 69.
The USPSTF’s recommendation against routine screening applies only to healthy men without symptoms of prostate cancer. The panel didn’t look at the value of testing in men with other symptoms or in those who have already had prostate cancer.
Who follows the USPSTF’s advice?
Most medical groups follow the task force’s advice, and federal programs like Medicare rely on its conclusions when deciding whether to pay for screening tests. However, in 2009, when the USPSTF rolled back its recommendations for routine breast cancer screening — advising against routine mammograms for women under 50 — the federal government said it would continue paying for the test for women in their 40s.
Since the PSA test is a blood test, what’s the harm in getting tested?
The test itself doesn’t pose any danger, but it’s the decisions that doctors and patients make based on its results that can be potentially harmful. More than 33 million men over age 50 have already received a PSA test during routine physicals, and many have gone on to have biopsies, surgery or radiation treatment based on the results. But because the PSA test carries a relatively high false positive rate, many of these procedures — and their side effects — have been unnecessary.
For example, the USPSTF’s draft report notes that between 1986 and 2005, one million men had surgery, radiation or both because of positive PSA results, who would not have been treated if they hadn’t gotten the test. Up to 300,000 of them suffered from impotence, incontinence or both as a result of complications from these procedures, and 5,000 died soon after their surgeries.