Friday, October 7 — The prostate specific antigen (PSA) test for prostate cancer has been the subject of controversy for some time. Many doctors contend that the screening leads to overtreatment and has little effect on death rates, while others argue that it's a life-saving screening tool. Now, with the news that the United States Preventive Services Task Force (USPSTF) is planning to recommend against the test next week, the debate is heating up again, inciting reactions from experts and patients on both sides of the issue.
The USPSTF is no stranger to controversy. Back in 2009, the group caused a similar firestorm when it recommended scaling back on routine mammograms for breast cancer. Previous guidelines recommended that all women age 40 and older should have annual screenings, but the USPSTF report suggested that women should start getting mammograms at age 50, and then only every other year. Breast cancer advocates worried then — as many prostate cancer advocates are concerned about now — that the decision would cause people to skip screenings altogether and miss out on early detection of dangerous tumors.
PSA opponents argue, however, that the tumors detected by the test often aren't dangerous and just end up causing unnecessary physical and emotional stress. "This test cannot tell the difference between cancers that will and will not affect a man during his natural lifetime," Dr. Virginia Moyer, a professor of pediatrics at Baylor College of Medicine and chairwoman of the task force, told the Times. "We need to find one that does."
PSA supporters don't necessarily disagree with that sentiment but contend that we shouldn't throw out the old screening method until we have a new one to replace it. "Though it is clear that we still need to find a better test to improve early detection of significant disease and to curtail over-treatment, it is not advisable to discourage use of a currently existing test that is proven to save lives," said Lionel L. Banez, MD, an assistant professor in the division of urologic surgery at Duke University Medical Center. (Find out more about the new recommendations and resulting controversy here.)
The issue is of particular interest to prostate cancer survivors, some of whom credit the PSA test with saving their lives. Many expressed their concerns in communities within the American Cancer Society's Cancer Survivors Network and Us Too's Inspire Support Groups:
What We Really Need Is More Awareness
"[We need] education to make this disease more public. At our state fair last August, we had prostate screenings, [and the volunteers] were women, wives dragging their husbands to the information table. Where were the men helping other men with this disease? If all the guys on this board start a local Man to Man group, maybe we can do something to help." — Sharon, USTOO
What Other Option Do We Have?
"I agree with the PSA test. How do we detect cancer? Do we wait until other problems show up? Maybe the test is not the greatest option available, but when it is the only option other than a DRE [digital rectal exam], it sounds like a winner to me." — Dakotarunner, ACS
"So we get rid of the PSA test. Then how do you detect cancer? I realize that the test is unreliable, but what else is there?" — NowRest, ACS
We Have to Weigh the Negatives Against the Positives
"The problem doesn't seem to be getting the test — the problem is acting on the test. As it stands now, we are treating all men if there's a positive biopsy, and as a result, many unnecessarily suffer the negative consequences of surgery (mainly incontinence and erectile dysfunction). On the other hand, the few men [with] high risk cancer are saved, making the effects of surgery less consequential." — Swingshiftworker, ACS
Early Detection Is Key
"Almost everything we read is that early detection is the key. What you do with the information [and results] can be harmful, but it can also be enlightening." — Dan, USTOO
Why Wait Until It's Too Late?
"I know young guys, under 65, who are diagnosed and seem to have a more aggressive prostate cancer. What do you do — wait until symptoms rear their ugly heads when a simple blood test can be watched?" — Kalchic, USTOO
PSA May Have Saved My Life
"My PSA had gone up from 3 to 5 in one year, so I had a DRE (negative) followed by a biopsy (positive). If I hadn't had the PSA test, I wouldn't have had the biopsy, and the cancer would have grown without being treated." — Tom, USTOO