It’s been a tough couple weeks for medical tradition. First we had all women being warned their calcium supplements may do more harm than good; now the medical community is in a tizzy over the new recommendations against using the PSA as a screening test for prostate cancer in men. Almost all older men are accustomed to getting this routine blood test, which they believed had been a good screening test for prostate cancer. The big problem with this cancer screening test, as I mentioned before, is that it is far from ideal. It misses a lot of true cancers; it over-diagnoses many benign conditions; many follow-up procedures leave the men impotent or with urinary problems; and there’s no proof that it improves survival.
This test has been on the ropes for a while but got a body blow last week when the US Preventive Services Task Force came out with their new recommendation — downgrading their 2008 recommendation from a Grade C to a D. This was a big deal: no longer is it the equivocal C level, it’s now the strongly worded “do not use PSA-based screening for prostate cancer“.
This new recommendation from America’s top agency now has the medical world in turmoil similar to the mammogram debate two years ago. But as I said before, evidence has been building that the PSA test is causing more harm than it is helping. I’ve talked with my male patients about this test for a while and now will be even more against it — but even in my own hospital we routinely perform this test as part of health packages for men, as do most hospitals. This new data will definitely be a hot topic at our next Journal Club meetings!
The sad part to this story, of course, is that there unfortunately is no excellent screening test for prostate cancer, which leaves men feeling vulnerable. In this age of “constant scientific progress”, to be told that your test is no longer considered useful is indeed unsettling. Let’s hope that the world’s scientists quickly come up with a more accurate screening test.