PSA Prostate Cancer Tests: Good or Bad? Adverse Risks & Side Effects?


A blood test that is currently used to screen for prostate cancer leads to frequent overdiagnosis, and this prompts men to undergo invasive treatments that harm them with painful and often life-altering side effects like impotence and incontinence.

Those were the findings of an investigative panel convened to advise federal authorities on the test’s efficacy. The panel’s report was publicized in October last year (2011).

Prostate cancer treatments leave many survivors with erectile dysfunction, incontinent, and with difficulty urinating and controlling bowel functions, says the U.S. Preventive Services Task Force (USPSTF) in its report, published in the Annals of Internal Medicine.

And patients are prompted to undertake treatments — surgery, radiation or hormone therapies — by a blood test designed to detect higher than normal levels of prostate-specific antigen, or PSA, in the blood, the experts say.

The PSA test has become increasingly controversial as more doctors and studies cast doubt on its effectiveness.







For one, a high PSA level can signal prostate cancer but it can also indicate conditions that are more benign.

Now the USPSTF says that at least a fifth to 30 percent of all men who get radiation therapy or surgery experience incontinence and impotence. For its report, the panel analyzed five of the largest studies on the PSA tests.

What’s worse, the experts’ panel said that in one European study it analyzed, the rate of overdiagnosis from PSA screening was estimated to be as high as 50 percent. Based on that study, if 1,410 men are screened, 48 will be found candidates for treatment — but just one life will be saved from prostate cancer.

A recent Johns Hopkins University study even found surprisingly high rates of hospitalization for bloodstream infections after prostate biopsies and a 12-fold greater risk of death in those who develop these infections.

The USPSTF concludes: the benefits of the PSA test appears minimal, while the downsides are considerable. “The vast majority of men who are treated do not have prostate cancer death prevented or lives extended from that treatment, but are subjected to significant harms,” it says.

“There are clearly people we harm with therapy,” Dr. Bruce Roth, professor of medicine at Washington University in St. Louis tells Madison Park of CNN. “I don’t think there’s doubt about that. We wouldn’t be having this conversation if the therapy was nontoxic.”

Yet the public perception is that if PSA testing finds a cancer early, this must be good. And many prostate cancer survivors swear by the test and subsequent treatments.

Defenders
For sure, there’s no overarching consensus on PSA testing today. Dr. Pat Walsh of Johns Hopkins University, a world-renowned urologist and pioneer in nerve-sparing prostate surgery, tells ABC news he thinks the panel’s recommendation is “a shame.”

“This decision ignores the fact that there has been a 40 percent reduction in prostate cancer deaths over the past 10 years since PSA testing has been in place,” Walsh says. “The USPSTF ignores this because it relies only on randomized trials, and there are a number that have too short a follow-up and other serious deficiencies.”

Dr. Leonard Gomella, chairman of urology at Thomas Jefferson University, called the decision an “appalling affront to all men who will die from prostate cancer.”

Dr. William Catalona, the Clinical Prostate Cancer Program at Northwestern Memorial Hospital director believes “the extent to which PSA screening causes over diagnosis and overtreatment is exaggerated.”

“I have to wonder whether economics are playing a role in the decision of the Task Force,” Dr. Jerome Richie, chief of urology at Brigham and Women’s Hospital tells ABC News.