BY: DR. JONATHAN STEINMAN
(NEW YORK) — An expert panel has recommended against routine blood screening for prostate cancer, in a report published Wednesday in The BMJ.
The panel, composed of general practitioners, urologists, methodologists and patients, cited five clinical trials which evaluated the use of a blood test for prostate-specific antigen (PSA) in screening for prostate cancer. Using this screening test led to no significant decrease in overall patient death, according to the study.
Prostate cancer screening has been a controversial topic in the field of medicine. PSA screening has definitely led to an increase in the detection of prostate cancer. “The problem is that the PSA test, the only test currently available, has a high incidence of false positive and false negative results, and many cancers detected through PSA are indolent and would never cause the patient any harm,” said Dr. Martin Roland, emeritus professor of Health Services Research at the University of Cambridge, said in an editorial. Current tests cannot reliably identify aggressive-behaving cancers, and those are the ones that can kill.
Novel methods of prostate cancer management, including prostate MRI and MRI-guided biopsies, are not widely available to use for the general population, despite promising results.
False positive PSA results cause unneeded treatments, and side effects from treatment can be significant. Not only can biopsies and surgeries cause infection, but they can also lead to urinary incontinence and erectile dysfunction. Following surgery, incontinence was seen in up to 17 percent of patients, and erectile dysfunction was seen in up to 83 percent.
The recommendations come following recent changes in the United States Preventive Services Task Force recommendations back in May of 2018. They now encourage PSA screening to be an individual decision. Neither recommend general population screening. The panel cautioned, however, that certain groups, such as those with a family history of prostate cancer, may want to consider PSA screening.
Dr. Jonathan Steinman is a radiology physician and writer with the ABC News Medical Unit.
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