Annual PSA test doesn't save lives

Researchers have found more evidence that annual prostate cancer screening, called PSA test,  in men doesn't save lives.   Scientists followed 76,000 men for 10 to 13 years and found annual screening for prostate cancer led to more diagnoses but didn't result in less deaths from the disease, according to a new study from the Washington University School of Medicine in St. Louis.

Last October, the U.S. Preventive Services Task Force (USPSTF) recommended against routine PSA screenings for most men because of similar concerns about the accuracy of screening using a blood test that measures a protein called prostate-specific antigen or PSA.

Dr. Otis Brawley,  the chief medical officer for the American Cancer Society said the harms of screening are better proved than the benefits,which is why he supports the USPSTF recommendations.  A substantial number of men receive unnecessary treatment because of the annual tests,which can lead to harms such as impotence and incontinence and can even lead to premature death, he wrote.

For the population at large, PSA screening may not be beneficial and the harms may outweigh the benefits, said Dr. Gerald Andriole, the study's lead author and chief of division of urologic surgery at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine.  The majority of prostate cancers are very slow-growing tumors and men will probably not die from it.  However, in the U.S. if a man is diagnosed with prostate cancer he's most likely going to choose the most aggressive treatment.

Researchers found that some subgroups of men did benefit from annual screenings.  "For the healthiest men, there was a significant reduction in prostate cancer mortality among men who got screened.  In addition to that group, also men who have strong family history of prostate cancer, and African-American men [who are twice as likely to die from  prostate cancer as caucasian men] should also get PSA testing," said Andriole.

"In the case of a man undergoing an annual checkup, I would not recommend that a PSA test be included with other 'routine' blood test without a specific conversation between the doctor and patient or caregiver and patient about the pros and cons for him, the patients specific circumstances," said Andriole.

Dr. Lee Ponsky, a urologist at University Hospitals Case Medical Center in Cleveland is part of a group of researchers looking at more sensitive ways of detecting prostate cancer. He said for now, "the PSA test is the best we've got, but it certainly has its shortcomings."

While researchers are looking into different ways of screening and how to classify prostate cancer once diagnosed, Ponsky said we are several years from a simpler test such as a blood or urine one that can detect cancer and determine whether or not it needs aggressive treatment right away.

The study was published Friday in the Journal of the National Cancer Institute.