Urologists concerned that they will see more patients with metastatic disease
Beverly, MA -- (SBWIRE) -- 02/08/2013 -- One in six men will be diagnosed with prostate cancer in their life and about 1 man in 36 will die from it, according to the American Cancer Society. However, with early detection and treatment, the odds of surviving prostate cancer are relatively high. The most common screening method other than by an examination is through a blood PSA screening test.
PSA tests measure levels of prostate-specific antigen, a protein produced by cells of the prostate gland, in a man’s blood. The level of PSA is often elevated when prostate cancer present. However, other factors may cause high levels and sometimes a patient with prostate cancer will produce low PSA levels. Consequently, the PSA test is not perfect, but it’s one of the few non-invasive tools available for early detection. Over the past 25 years since PSA became commonly use there has been a 42% decrease in the mortality rate from this cancer.
In May 2012, the US Preventive Services Task Force (USPSTF) claimed “there is moderate certainty that the benefits of PSA-based screening do not outweigh the harms” and “there is a very small potential benefit and significant potential harms.” Indirectly, the task force had issued a recommendation against PSA testing.
The opinion of the USPSTF, a committee authorized by the Patient Protection and Affordable Act, to provide health care recommendation to Congress and other agencies, continues to generate debate among within the medical community. Following the USPSTF’s report and recommendations, the American Urological Association (AUA) promptly refuted the decision and asserted the benefits far outweighed the risks.
USPSTF’s warning against PSA screening for prostate cancer is primarily based on the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. The PLCO study sought to determine if certain cancer screening tests reduce the risk dying of prostate, lung, colorectal or ovarian cancer. It includes nearly 76,693 people ages 55 to 74 with no previous history of prostate, lung, colorectal, or ovarian cancer. These participants were randomly assigned to either a PSA Screening arm (an organized screening program within the trial) or Non- Screened arm. However, 52% of the participants in the Non- Screened arm received PSA screenings and subsequent care diluting any potential statistical difference between the groups. Despite such a high contamination of the control group in the study, the USPSTF accepted the study’s conclusion that PSA screening tests had no impact on the prostate cancer mortality rates.
The PLCO trial findings significantly conflict with the findings of the European Randomized Study of Screening for Prostate Cancer (ERSPC). The findings in the ERSPC study revealed a 29% decrease in mortality in PSA screened men. Despite the disparity between the ERSPC and PLCO studies, USPSTF went ahead with its recommendation against PSA screenings.
Since the USPSTF recommendations, Urologists and screening clinics are noticing a continual decrease in PSA test referrals. Data presented at the American Public Health Association (APHA) 140th Annual Meeting revealed http://www.apha.org/ cancer screening. The presentation attributed this downward spike was due to the highly publicized PLCO study that suggested PSA screening has no statistical impact on cancer mortality rates.
“The impact of USPSTF’s ruling on PSA testing will have a negative impact on men’s health and prostate cancer mortality rates. It significantly reduces the ability to catch prostate cancer in its early stage. It’s anticipated that we will see more patients with metastatic disease,” says Dr. Michael Geffin, a Urologist at North Shore Urological Associates in Beverly, Massachusetts and recipient of the Physician Recognition Award from the American Medical Association in 2002.
“I and many other Urologists are concerned that many men will wait until they have advanced symptoms and, at that point, we have a lot fewer treatment options.”
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