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Evidence is against PSA testing – but will that change anything?

The United States may be about to abandon one of the most widely used – and controversial – cancer screening techniques.

PSA (prostate specific antigen) testing for prostate cancer has no benefit in healthy men, the United States Preventive Services Task Force (USPSTF) will say next week, according to The Cancer Letter and the New York Times.

In a new analysis of the evidence on PSA testing, the USPSTF says that, after 10 years, screening healthy men gives a “small or no reduction” in deaths from cancer and brings risks which may be unnecessary. (The review has been posted online by The Cancer Letter.)

“Unfortunately, the evidence now shows that this test does not save men’s lives,” says Virginia Moyer, the chairwoman of the USPSTF in the Times. “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.”

America’s approach to PSA testing has long been viewed with suspicion by many doctors in other countries, as well as some US physicians.

Although many men die with prostate cancer, the argument runs, relatively few actually die from prostate cancer. Aggressively treating men based on high PSA levels runs the risk of giving them impotence and/or incontinence while not actually reducing their risk of dying from cancer.

In an article published earlier this year, doctors Nathan Hitzeman and Michael Molina, of the Sutter Health Family Medicine Residency Program in Sacramento, California, note, “Several large randomized controlled trials show that PSA screening does not significantly reduce prostate cancer mortality, even in a US study that included black men and men with a family history of prostate cancer. However, PSA screening does lead to over diagnosis, overtreatment, and treatment-associated morbidity.”

As the Times points out, Medicare has to pay for PSA testing due to legislation but the government has already been accused by Republicans of rationing health care. A previous USPSTF recommendation on breast cancer screening was ignored by the administration. Ignoring the evidence on PSA testing as well might give the easiest ride politically, as PSA advocates are already out in force, but it could severely damage Obama’s credibility for evidence based policy making.


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