Warning on PSA screening draws criticism

WASHINGTON -- Men who hoped to finally get a clear message about undergoing PSA screening for prostate cancer may have to keep hoping.

The vast majority of men over 50 already get tested, but now comes a government panel that says finding cancer early can harm instead of help. That's a hard concept to swallow, yet it's at the heart of the panel's draft recommendation that PSA blood tests should no longer be part of routine screening for healthy men.

The new advice is already becoming controversial, and some doctors are rejecting it.

"We all agree that we've got to do a better job of figuring out who would benefit from PSA screening. But a blanket statement of just doing away with it altogether . . . seems over-aggressive and irresponsible," said Dr. Scott Eggener, a prostate cancer specialist at the University of Chicago.

The U.S. Preventive Services Task Force said the evidence it examined showed little if any reduction in deaths from routine PSA screening. Instead, it concluded, too many men are diagnosed with tumors that never would have killed them and suffer serious side effects from resulting treatment.

That recommendation isn't final -- it's a draft open for public comment. But it goes a step further than several major cancer groups, including the American Cancer Society, which urges that men be told the pros and cons and decide for themselves.

In the exam room, explaining the flaws in PSA testing has long been difficult.

"Men have been confused about this for a very long time -- not just men patients but men doctors," said Dr. Yul Ejnes, a Cranston, R.I., internal medicine specialist and chairman of the American College of Physicians' board of regents.

He turned down his own physician's offer of a PSA test after reviewing the research.

"There's this dogma . . . that early detection saves lives. It's not necessarily true for all cancers," Ejnes said.

That's an emotional shift, as the American Cancer Society's Dr. Len Lichtenfeld said on his blog on Friday.

"We have invested over 20 years of belief that PSA testing works. . . . And here we are all of these years later, and we don't know for sure," he wrote. "We have been poked and probed, we have been operated on by doctors and robots, we have been radiated with fancy machines, we have spent literally billions of dollars. And what do we have? A mess of false hope?"

Too much PSA, or prostate-specific antigen, in the blood only sometimes signals prostate cancer is brewing. But most men who undergo a biopsy based on an abnormal PSA test turn out not to have prostate cancer.

Why not screen in case there's a mortality benefit that studies have yet to tease out? The task force noted that, for one thing, 30 percent of men treated for PSA-discovered prostate cancer suffer significant side effects from the resulting treatment.