PSA test gets a new grade: a gentleman’s C

A burst of bad headlines and not so great news reports may have confused some men. But to put it in lay terms:  The use of the common test for routine prostate cancer screening got a dim grade of C for many men, up from a dismal D, in a re-evaluation by independent experts who assess the nation’s preventive medical services.

That blunt review of regular prostate-specific antigen (PSA) tests, despite some reports to the contrary, keeps with how the influential U.S. Preventive Services Task Force (USPTF) looked at annual  screening for this most common form of cancer for men when it issued its first guidelines in 2012, notes healthnewsreview.org.

The health information site says the USPTF earlier had surprised many, downgrading routine prostate cancer screening to a D, and noting, “There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” It now says it rates a C for many men younger than 70, meaning physicians should “Offer or provide this service for selected patients depending on individual circumstances,” and that “There is at least moderate certainty that the net benefit is small.”

Most men, especially those in the disease’s prime target ages 55 to 69, should discuss PSA testing’s benefits and harms with their doctors and make a personal decision about whether to undergo it. That’s good guidance for any test that has stood for some time, too.

As I have written, medical science is re-evaluating the risks and benefits of some common cancer screenings like the PSA and mammograms and their resulting therapeutic approaches. Both can be useful in early detection of possibly cancerous conditions. But the PSA, especially, lacks discernment, especially in showing if a patient may gave a lethal, fast moving form of prostate cancer or a slow growing type that can be monitored and largely left alone.

Meantime, widespread, frequent PSA use has led to more testing, to invasive and painful procedures, including biopsies, and to aggressive therapies that don’t add to the quality of life or longevity of men, many of whom already are older when the disease is detected, research has shown.

Specialists are carefully considering a different way to treat detected prostate cancer: Data show value in “watchful waiting,” an approach in which doctors and patients closely monitor but largely leave alone many prostate cancer cases, instead of leaping into radical therapies like surgeries or radiation treatments that can cause severe side-effects, including sexual dysfunction and incontinence.

In my practice, I see the significant harms that patients can suffer when seeking medical services, especially in cancer misdiagnoses. The cost of caring for those with this illness is skyrocketing now, and we need to do all in our power to ensure that our spending against it is wise and effective. Over testing and needless and ineffective care aren’t beneficial. They cost us billions of dollars annually.