Do Men Really Need the PSA?

There are 44 million men in the U.S. who are 50 and older, and 33 million of them already have had a Prostate-Specific Antigen test, or PSA test, which long has been touted as an important tool for early detection of prostate cancer. That's why it came as such a shock this week when news broke that a key government panel will recommend that men no longer routinely take the PSA test because, from a statistical standpoint, its use actually may do more harm than good.

The U.S. Preventive Services Task Force has issued a draft report concluding that, based on five major clinical trials, the PSA test does not significantly reduce the mortality rate from prostate cancer, which kills nearly 34,000 men annually. Moreover, the panel found that the PSA test's routine use actually leads in many cases to tests and treatments that needlessly subject men to side effects such as impotence and incontinence.

The report quickly came under attack from other medical experts and cancer activists, who challenge its validity.

According to the American Cancer Association's fact sheet, the PSA test, which was developed in the early 1980s, is designed to detect elevated levels of prostate-specific antigen, a type of protein produced by the prostate that is normally present in the male bloodstream in low levels. An elevated PSA level is a possible indication of prostate cancer, though it also can be caused by non-life-threatening conditions such as prostate inflammation or enlargement -- which, like cancer, are more common as men age. The PSA test by itself doesn't give doctors enough information to tell the difference, so a positive result usually leads to more tests.

But the government-appointed medical experts now say PSA isn't that good of an indicator of prostate cancer. One of the report's most unsettling revelations: In a study conducted in Finland, nearly 12 percent of subjects received false positives from the PSA, even after it was administered three times. Moreover, three-quarters of the men in the trial who recorded elevated PSA levels and were given prostate biopsies turned out to be cancer-free.

As this New York Times article details, the task force found that between 1986 and 2005, a million men received surgery, radiation therapy, or both as a result of PSA test scores. As many as 300,000 of them suffered impotence, incontinence, or both as a result of the treatments, and up to 70,000 suffered other serious complications. If the PSA isn't a reliable indicator, much of that suffering may have been unnecessary. The Times quoted one medical researcher, Richard J. Ablin, who has called widespread use of the test a "public health disaster."

But other experts quickly attacked the government panel's conclusions. Dr. Deepak Kapoor, who heads the nation's largest urology practice, tells The Times that "we will not allow patients to die, which is what will happen if this recommendation is accepted." In this CBS News story, Dr. Scott Eggener, a prostate cancer specialist at the University of Chicago, called the panel's conclusion "over-aggressive and irresponsible."

The government panel's report isn't final and won't prevent doctors from prescribing the PSA test, which Medicare is required by law to pay for, according to The Times. But it may discourage some physicians and deter men from taking the test. That worries some men's health activists and prostate cancer survivors. One of the latter, financier turned philanthropist Mike Milken -- most famous for his role in a 1980s Wall Street insider trading scandal -- writes a newspaper opinion piece titled "Why block a cancer test that saves lives?"

This isn't the first time that the task force has stirred up controversy. In 2009, it raised a similar brouhaha by opposing routine mammograms for women under 50.