If you’re a male, there’s a huge chance that at one point in your life you’ve heard of the importance of the
PSA test. Whether it was from your doctor, your father, or some news report, you’ve likely been exposed to some sort of information about this screening for prostate cancer. So it may come as some surprise that the United States Preventative Services Task Force, or USPSTF, has ruled that men should not seek routine blood tests that target prostate cancer.
This is the same advisory panel that ignited a huge controversial subject in 2009 when they ruled
against the use of annual mammograms in average risk women. They suggested that the checkup could result in unnecessary radiation, and the risk that resulted from biopsies and screenings far outweighed the benefits. Fast forward to 2011, and the USPSTF is now recommending that men avoid prostate specific antigen (PSA) testing, for much of the same reasons.
Citing the PSA test's already controversial nature as a major reason for its decision, the task force explains that the PSA test has not been shown to reduce the number of deaths resulting from
prostate cancer. The USPSTF studied the results of five major clinical trials around the world, and based its decision on these outcomes.
The biggest trial took place in Europe and studied over 182,000 men over the span of nine years. Researchers were unable to see a reduction in prostate cancer-related deaths when they compared the group of men who underwent the prostate exam to the group of men that didn't receive it. An American trial was also large, involving over 77,000 men. Very similar to the European clinical trial, this test also showed no reduction in the number of deaths among the men. The three other trials also showed similar results, and provided no evidence that prostate exams did anything beneficial.
Further complicating the matter is the fact that prostate cancer tends to grow very slowly, and may never become fatal. Of course, there are still instances where the cancer can grow very fast and aggressively, and become deadly. The USPSTF states that the PSA test cannot tell the difference between these two types of prostate cancer, and that a test that could detect this difference would be much more useful than the current prostate exam.
One surprising outcome from the clinical trials, however, is that the screenings were more effective when performed on healthy young men under the age of 40. This means that the generally accepted guideline of taking the PSA test annually if you are a male under the age of 65 might be too lenient.
Just because the United States Preventative Services Task Force has given the PSA test a thumbs down does not mean that they will keep the ruling. Before anything is finalized they must first allow a window of time for public commentary on the decision, and then they must review these comments and consider what the best step is.
If you are still interested in taking the prostate exam, experts recommend that you refrain from any sexual activity prior to the exam, and that you don't participate in bicycle riding, horseback riding, or a colonoscopy around the time of the exam. Overtreatment will be a continuous problem until scientists can find a way to identify a more accurate prostate exam that would be able to detect if the patient will develop a slow growing prostate cancer, or the more aggressive, malignant version that could prove to be fatal.
