U.S. task force recommends against routine PSA screening for prostate cancer

TORONTO Routinely screening men for prostate cancer with PSA tests can result in far more harm than good, says a U.S. expert panel in a recommendation against the practice that is sure to fuel continued debate over the issue.

On Monday, the U.S. Preventive Services Task Force released its final recommendation, advising against routine PSA blood tests to detect possible prostate cancer, the third most common cause of cancer death in North American males after lung and colorectal cancer.

Having an elevated level of PSA, or prostate-specific antigen, can flag the presence of cancer. But it can also be a sign of a benign enlarged prostate or infection, and most men who have a biopsy in response to an abnormal PSA test dont end up having cancer.

Often when prostate cancer is found through screening, the tumour is small and too slow-growing to be harmful, and many men end up dying of another cause. Yet theres no way of knowing which tumours are potentially deadly requiring aggressive treatment and which are not.

Almost all men with PSA-detected prostate cancer opt to receive treatment. Besides complications from the biopsy, there can also be serious adverse effects from treatment.

Its important for doctors and patients to understand that our current approach to screening for prostate cancer does not serve men well, said task force chair Dr. Virginia Moyer.

Basically out of 1,000 men who are screened, one man will not die of prostate cancer who otherwise would have died of prostate cancer, said Moyer, a professor of pediatrics at the Baylor College of Medicine.

The recommendation is that men not be routinely screened for prostate cancer using PSA, she said from Houston. We came to that conclusion because the science now is that there is at most a very small benefit and that is actually not a certain benefit.

The groups final recommendation, published in this weeks Annals of Internal Medicine, follows a similar draft statement in October and consideration of subsequent public comment. The advice applies to men of all ages, but not to those who have been diagnosed with or are being treated for prostate cancer.

As part of its research review, the panel considered two large trials of PSA screening in men without any symptoms to assess the tests life-saving benefits. The first trial, conducted in the U.S., found no drop in prostate cancer deaths. The second, conducted in seven European countries, found about one death in 1,000 was prevented in men aged 55 to 69 years, mostly in two countries.

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U.S. task force recommends against routine PSA screening for prostate cancer