No healthy man should get the PSA blood test to screen for prostate cancer, says the influential US Preventive Services Task Force in a new, strongly worded recommendation. As readers of this blog know, this recommendation has been a long time coming.
Prostate removal surgery, even in the most skilled hands, has a high rate of causing incontinence and impotence in the patient. So a test that detects early prostate cancer is valuable only if it prevents early death. The problem is the PSA test can’t tell the difference between cancers that are so slow-growing they will never kill a man and those that can be deadly. Hence it directs millions of men to biopsies and extensive operations of uncertain value.
We reported in 2009 that two huge studies were published that year that found zero benefit for PSA testing in one American study and only a tiny benefit, but much more harm, in the European study. Seven lives were saved for every 10,000 men tested, but in the same 10,000, forty-eight were harmed by unnecessary surgery.
Last year, also as we reported, the inventor of the PSA test decried its widespread use and said it should be limited to monitoring men who already have had their prostates removed and need a marker of possible return of the disease.