Panel recommends against annual PSA test

Healthy men 50 and older do not have to undergo annual screening for prostate cancer, according to a panel that has given the PSA blood test a grade of D and said it does more harm than good.

The U.S. Preventive Services Task Force, a committee of independent health experts empaneled by the U.S. Department of Health and Human Services, published its final report Monday on such screening in the Annals of Internal Medicine.

Even though the panel had invited public comment last fall after the release of a preliminary decision, the final report doesn't veer in content or tone.

The final document keeps intact the controversial stance against the PSA, noting that men 50 and older without prostate cancer risk factors -- such as being African-American or having a familial link to the disease -- can skip the annual screening.

"The final recommendation, which is unchanged after consideration of public comment, will upset many in the prostate cancer advocacy community," Dr. Otis Brawley, chief medical officer of the American Cancer Society wrote in a perspective article published Monday in the same journal.

The cancer society maintains that men should decide on PSA screening after having a frank discussion with their physicians.

The test detects a protein known as prostate-specific antigen, which is elevated in men with prostate cancer.

However, the test is also riddled with flaws and is notorious for producing false positives, a factor underscored by the task force. For instance, the PSA spots inflammation in the prostate, which may lead to a biopsy and other expensive cancer diagnostic exams.

Despite the PSA's problematic past -- and uncertain future -- many doctors on Long Island stand behind it.

Dr. Howard Adler, medical director of the prostate care program at Stony Brook University Medical Center, said the PSA is the best test medicine has at the moment.

"I would say that the entire urological community stands united behind saying this [the recommendation] is not a good idea. . . . Right now, it's the best tool we have. In fact, we cannot even begin to discuss the management of prostate cancer unless we diagnose it," Adler said.

Dr. Deepak Kapoor, president of Advanced Urology Centers, which has offices on Long Island and in New York City, said the recommendation is an outrage.

"Until we find something better, I recommend that every man who is 50 and older should have a discussion with his doctor about the PSA and every African-American man who is 40 and older should have that discussion with his doctor.

"If it's appropriate for the president of the United States to have a PSA," Kapoor said, noting that President Barack Obama, 50, had the screening during a physical last year, "then it's appropriate for other men to have that opportunity."

The Obama administration issued a statement Monday saying Medicare will continue to pay for PSA testing, and private insurers generally comply with Medicare's payment policies.

Dr. Felix Badillo, chief of urology at St. Francis Hospital, was equally upset with the decision.

"Based on my own data, I have treated over 1,600 men with prostate cancer, and over 95 percent of them were diagnosed by the PSA exam," he said.