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Do PSA Tests for Prostate Cancer Improve Early Detection?

The failure of a physician to timely diagnose cancer is a problem. We are told that early detection of a cancer leads to a better outcome, and the longer the delay in diagnosis of a cancer reduces the likelihood the cancer can be cured. For the last 20 years, physicians have recommended a prostate-specific antigen (PSA) test every year or two to detect prostate cancer early.

On May 22, 2012, the U.S. Preventive Services Task Force (USPSTF), a panel of physicians, Ph.D’s, and nurses, released a recommendation against PSA screening tests for prostate cancer. The Co-Chair of the USPSTF made the following statement:

“Prostate cancer is a serious health problem that affects thousands of men and their families. But before getting a PSA test, all men deserve to know what the science tells us about PSA screening: there is a very small potential benefit and significant potential harms. We encourage clinicians to consider this evidence and not screen their patients with a PSA test unless the individual being screened understands what is known about PSA screening and makes the personal decision that even a small possibility of benefit outweighs the known risk of harms.”

The report states that a better test and better treatment options are needed. The recommendation against PSA testing does not apply to men who have already been diagnosed with prostate cancer.

According to the Task Force, prostate cancer is the most commonly diagnosed non-skin cancer in men in the U.S., with a lifetime risk for diagnosis estimated at approximately 16%. The Task Force claimed there is “convincing evidence” that most cases of prostate cancer have a good prognosis without treatment because it is slow growing and is typically diagnosed in older men, who die of something else.

The foundation of the Task Force’s recommendation is two major clinical trials, one conducted in the U.S. and one in Europe. The trial in the U.S. claimed no reduction in deaths due to PSA screening, and the one in Europe reported a reduction of 1 death per 1000 men screened.

The trials reportedly showed that the PSA test is unreliable because of so many false-positive results when normal levels are considered to be 2.5 and 4.0. Treatments for prostate cancer often include radiation therapy and surgery, which the Task Force reported caused urinary incontinence and erectile dysfunction in at least 200 to 300 of 1000 men. Other complications include heart attack, stroke, blood clot, and death according to the report.

The Task’s Force report is being criticized by some in the medical community. The Prostate Cancer Foundation (PCF) does not agree and continues to support routine screening until new clinical guidelines are released and is concerned that the Task Force will create patient confusion and caused a delay in diagnosis of prostate cancer.

The bottom line is you should make an informed decision after talking to your physician. No one wants to find out that the diagnosis of their cancer, any cancer, was delayed and as a result their chance of cure is less.

This PSA test update was written by Randall E. Robbins, a Delaware cancer misdiagnosis lawyer with experience helping clients whose cancer was missed or diagnosis delayed due to medical negligence.