PSA screening rates going down as a result of Task Force study

Since the U.S. Preventive Services Task Force (USPSTF) issued a recommendation statement in 2012 that advised all men not to use the PSA screening in order to look for prostate cancer, more and more men refuse or postpone the test until there is a significant reason for worrying.

The recommendation was issued on the basis that most men that have a positive test result have minimal forms of cancer that, most likely, will not progress or will grow so slowly that they won’t have time to pose any threat during a man’s lifetime. Confronted with the diagnosis, some men will undergo treatments that will affect them for the rest of their lives, due to the common side effects, such as urinary incontinence or sexual dysfunctions.

The overall consensus is not to abandon the PSA test in every circumstance, but that men and their physicians discuss what are the patient’s concerns, if there are risk factors, such as genetic ones, or how comfortable he is with not being in full control of this aspect. There still are public health organizations that support PSA testing and physicians that may continue to offer it, based on their beliefs about screening and interpretation of clinical trial results.

However, there are clear studies from the American Cancer Society regarding the effects that the USPSTF recommendation had on the PSA screening rates. It appears that in 2013, after retracting support for the screening of men of all ages, the number of men that got tested decreased by 7%, compared to the 38% rate in 2010. In 2015, according to the same institution, the rates seemed to recover a little, reaching a 32% level.

Dr. Alex Krist who is a member of the USPSTF and an associate professor of family medicine and population health at Virginia Commonwealth University explained the task force’s recommendation. Statistically speaking, of 1000 men who receive the prostate-specific antigen test, 240 will get a positive result and will be required to get a biopsy. Out of these men, a big portion of them will not find any cancerous cells. 20-50% of those who will test positive for prostate cancer will actually be over-diagnosed with cancer that will never grow, spread or harm them. Out of the initial 1000 men tested, one will be prevented from dying of prostate cancer and three will be prevented from developing metastatic prostate cancer.

Often times, after a diagnosis of prostate cancer, the physician may prescribe a form of treatment more aggressive than necessary, or the patient will not feel comfortable with the active surveillance or watchful waiting course of action. Taking all of these into consideration, it’s clear that the final decision regarding screening must be taken by the patient. Once he is informed of all the risks that diverge from this test and the possible treatment that may follow, he has to balance all the facts and chose the option that best aligns with his interests. If prostate cancer is a diagnosis that scares him and it’s more important to feel safe about it, rather than live the rest of his life with possible side effects from treatment, then he should get regular PSA checks. On the other hand, if he feels confident in his health and he’s more concerned of the urinary continence issue and sexual dysfunctions, he could postpone the PSA test until later in life.

The USPSTF discourages the practice of PSA testing for men over the age of 70, due to the fact that, in most cases, the harms outweigh the benefits. The recommendations that the task force issues are only applicable to patients with no obvious signs or symptoms, or those who haven’t been previously diagnosed and treated of prostate cancer.