Prostate Cancer Screening – Is Science Winning?

Joe Paduda

First posted 10/07/11 on Managed Care Matters

Brian’s Note: Readers interested in this topic will also want to see “Can Cancer Ever Be Ignored” by Shannon Brownlee and Jeanne Lenzer, published yesterday in the New York Times Magazine.

The announcements this week that the United States Preventive Services Task Force has decided healthy men shouldn’t get the P.S.A. blood test is long overdue, but nonetheless very welcome news.

The test, which ostensibly screens for prostate cancer, is notoriously inaccurate, delivering a high rate of false positives and false negatives. And, men who get these tests have no greater chance of surviving the test than men who don’t.

Seventy percent of positive PSA tests are false positives; the patient does not have prostate cancer. Worse, these false positive tests often result in more tests and treatments that then result in impotence and incontinence and in some cases, premature death. According to the chair of the Task Force, “This test cannot tell the difference between cancers that will and will not affect a man during his natural lifetime. We need to find one that does.”

Over a twenty year period, about a million men got prostate surgery, radiation, or a combination as a result of a PSA test. Of those, about 5000 died soon after surgery, and from 10,000 to 70,000 suffered serious complications, and 200,000 to 300,000 were incontinent, impotent, or both. The dimension of the problem was starkly illustrated when the test’s developer called its widespread use “a public health disaster.”

There are passionate and dedicated folks who will argue vehemently that PSA tests are necessary and save lives. Unfortunately, many have become part of a campaign financed almost entirely by the pharmaceutical industry. I engaged in a dialogue for some time with one of them, and despite my best efforts, his conclusion is that the test saved his life and therefore others should get it as well.

It’s one thing to talk population health and an entirely different thing when one is talking about the health of one’s family or self. Unfortunately, well-meaning people often confuse the two – and this is what has led them to advocate for a test that is:

– costly (PSA tests range in cost from $70 – $200, plus the office visits, or about $3 billion a year just for the tests in the US);

– results in surgery that kills about five thousand men over a twenty year period and

– causes impotence and/or incontinence in 20% to 30% of patients

Some will argue that more recent developments in surgery have delivered better results – I’d say it’s too early to tell, which is why the Task Force used a database that would allow them to see effects over the long term.

What’s the net?

PSA testing is a great example of business masquerading as good medicine, funded by businesses who profit from the test, who arguably, are partially responsible for the deaths and suffering of thousands of men.

It’s also a great lesson on why we need more science education in our schools, so so many of us would actually understand what a disaster the PSA test has become.

Joe Paduda is a health analyst writing at Managed Care Matters.

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