December 14, 2007

Despite lack of evidence, use of PSA test increases

A study in a recent issue of the Archives of Internal Medicine tracked use of the prostate specific antigen (PSA) test for prostate cancer between 1995 and 2004. It concluded: "despite the lack of clear evidence of benefit, PSA testing for prostate cancer screening has increased dramatically, especially among black men and younger men."

This week, a letter to the BMJ (subscription required for full text) from two French physicians reacts to a recent report on the feasibility of PSA testing in men ages 45-49. They write:

"Screening for prostate cancer in men older than 50 is hardly acceptable because overdiagnosis is obvious and the impact on mortality remains unproved despite the findings of numerous trials in the past 15 years.

Of 19 major medical organisations worldwide, only the American Cancer Society and the French and American urological associations recommend screening men for prostate cancer with annual measurement of prostate specific antigen (PSA). Therefore, in addition to wasting resources, the paper by Lane et al will be used to promote screening. In France 36% of men underwent prostate cancer screening (unproved and not organised), whereas only 25% underwent colorectal cancer screening (proved benefit on mortality and organised). The only demonstrated effect of prostate cancer screening is a 5-10% biopsy rate in the screened population, with a risk of septicaemia and haemorrhage. Plus, for those treated, various adverse effects (impotence, incontinence, pain, rectal ulcers, etc)."

Posted by schwitz at December 14, 2007 08:19 AM | TrackBack
Comments

What do you think of this talk about prostate cancer statistics: http://www.laprp.com/article.php?aid=348 ?

Posted by: ak at December 16, 2007 06:03 PM

Actually, the American Cancer Society no longer recommends PSA testing. The ACS says it is "inappropriate" for doctors to "recommend" the test for average-risk men, but that it is also
"inappropriate" to "discourage testing" and that doctors should "offer" the test and then engage in "shared decision-making" discussing possible benefits, risks and side effects with the patient.

In the U.S. that leaves the College of Urologists as the only group still recommending PSA testing.

Posted by: maggie mahar at December 20, 2007 01:57 PM
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