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No PSA Tests, Advanced Cancer Triples

Posts: 694
Joined: Apr 2010


Study: No PSA Tests, Advanced Cancer Triples
By Charles Bankhead, Staff Writer, MedPage Today
Published: July 30, 2012
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Action Points
•Elimination of PSA testing would triple the number of men who have advanced prostate cancer at diagnosis, this study suggests.

•Point out that the findings have potentially major implications in light of the recent U.S. Preventive Services Task Force (USPSTF) recommendation against routine PSA screening tests.

Elimination of PSA testing would triple the number of men who have advanced prostate cancer at diagnosis, authors of a retrospective review concluded.

Extrapolation of cases from the pre-PSA era to 2008 showed that the number of metastatic (M1) prostate cancers at diagnosis would increase from 739 to an estimated 2,277, in a review limited to a National Cancer Institute database.

Further extrapolation of cases in the database to the entire population resulted in an increase from 8,000 to 25,000 cases of M1 prostate cancer at diagnosis.

The findings have potentially major implications in light of the recent U.S. Preventive Services Task Force (USPSTF) recommendation against routine PSA screening tests, according to an article published online in Cancer.

"Our analyses suggest that, if the pre-PSA era incidence rates were present in the modern U.S. population, then the total number of men presenting with M1 prostate cancer would be approximately three times greater than the number actually observed," Edward M. Messing, MD, of the University of Rochester in New York, and co-authors wrote in conclusion.
"We believe that these estimates must be taken into consideration (bearing in mind the limitations of observational data) when public health policy-level recommendations are made regarding PSA screening."

Conflicting clinical evidence and guideline recommendations have made PSA testing a hot-button issue in U.S. healthcare policy. Three years ago, published results of two large screening studies showed different outcomes: a large European study demonstrated a survival benefit with PSA screening and a large U.S. study suggested that screening did not reduce the risk of prostate cancer mortality.

Long-term follow-up in the U.S. study confirmed the lack of a survival benefit.
Last year the USPSTF issued a conditional recommendation against PSA screening for prostate cancer as a component of routine care. Earlier this year the task force finalized the recommendation, as its panelists concluded that screening asymptomatic men had the potential to cause more harm than good.

The American Cancer Society threw its support behind the USPSTF decision, whereas the American Urological Association condemned the recommendation and reaffirmed its support for risk-guided PSA screening.

Earlier this month the American Society of Clinical Oncology issued a provisional clinical opinion that discouraged PSA screening of men with a life expectancy of less than 10 years and that encouraged individualized decision making for patients with a longer life expectancy.
Messing and colleagues sought to inform the debate by seeking evidence from a different perspective. Specifically, they examined the age- and race-specific annual incidence of M1 prostate cancer at diagnosis in the era before PSA testing became widely available and compare the rates with those in the most recent years of the PSA era.

The investigators also estimated the number of men who would be expected to have M1 prostate cancer at diagnosis in the current era if PSA testing were not available. For purposes of their calculations, they defined the pre-PSA era as 1983 to 1985.
Examination of the current era consisted of data from participating registries in the Surveillance, Epidemiology, and End Results (SEER) program for 2008, the most recent year with complete data.

Analysis of the SEER data showed that 739 men had M1 prostate cancer at diagnosis in 2008. On the basis of diagnoses in the period from 1983 to 1985, the number of M1 cases would have increased to 2,277 had PSA testing not been available in 2008, an expected-to-observed ratio of 3.1 (95% CI 3.0 to 3.2).

Applying the ratio to the general population, Messing and colleagues estimated that 25,000 men would have had M1 disease at diagnosis in 2008 in the absence of PSA testing. In contrast, the observed number of M1 cases at diagnosis in 2008 was 8,000.

The results also have relevance for several recent studies suggesting that PSA screening can be safely stopped after age 75.

"We observed that, for both races, the apparent benefit of screening in terms of the absolute reduction in the risk of presenting with M1 prostate cancer increased with age," the authors wrote. "In particular, differences in the rates during the pre-PSA era and the PSA era in presenting with M1 prostate cancer increased with age until age 85 years."

ralph.townsend1's picture
Posts: 359
Joined: Feb 2012

I know for a fact. If my doctor had not been testing me each year, starting at the age of 47 and continue to 58 when they found that the psa had jump to 6.8. It would had cost alot more than money and time if I had not been tested. The PC would have been more than the Lymph nodes. I see a lot of guys down at MD Anderson with Bone, lungs, ETC. The main reason is they did not get psa testing every year. I know thats not all cases.

laserlight's picture
Posts: 165
Joined: May 2012

My doctors started to check my psa level at the age of 50. For years it was low in the .5 to .8 range. Back in Nov of 2010 my psa level jumped to a 1.25, this still under the radar. My current doctor noticed and sent me to the Urologist, this doctor looked at the results and ordered the FREE psa test, by that point in time my psa jumped again. This triggered biopsy that came back with agressive prostate cancer. All 18 samples had cancer it had spread thru out, at time of surgery stage T2C PSA level of 4 . There is something wrong with the concept of " Trust Me I am from the Goverment and I am here help" psa testing is needed for all males over the age of 50. Mine was caught just in time. Everytime the goverment gets involved they screw up big time.

hopeful and opt...
Posts: 1643
Joined: Apr 2009

" Everytime the goverment gets involved they screw up big time."

I am still angry about the study and decision that tssk force came out. Resulting from this , many lives will be lost.Additonally many more men will suffer a horid existence during the later part of their lives.

Posts: 814
Joined: Mar 2010

I don't think anyone in the profession is even thinking about following the USPSTF "recommendation" to suspend routine PSA screening for men 50 and over. There's just too much money in it for them.

I guess there's a possibility that some ill-informed men might forgo testing if they happen to read about the recommendation BUT further reading would easily dispute the wisdom of doing that.

So, I really don't think there's any need to worry about this. PSA testing is NOT dead and will continue as a normal part of screening men for prostate cancer.

Posts: 351
Joined: Jan 2011

I believe most doctors will not follow these guidelines. Not sure about the VA. My PSA went from 4.00 to 6.4 in six months. Urologist at VA said no worries he had seen this many times. He was going to schedule surgery for me up in Richmond, VA in a few months. I had already gone to a urologist and scheduled surgery. Surgery showed it had spread to the bladder, and showed a nodule in lung. VA is so busy that I can not blame my GP there for not reading the report. Fact is I never told her. When I found out. My worry would be, as busy as the VA is, they stop checking PSA then most VN Vets are going to die. If you look at it from a monetary view the VA will save alot of money if they stop checking.

laserlight's picture
Posts: 165
Joined: May 2012

Right after this study was released Fox News on their Sunday morning program had their Sunday morning house call. The 2 doctors blasted this study and had some strong words. Any body that has been in treatment for this knows how bad it is. My doctor explained to me that this cancer is treatable to a certain extent if caught early enough. The problem is that of people that make these decisions, this was one of the most backwards, unscientific study to date. When I was informed about having PC, It was a kit in the gut big time, but I am glad that I had 2 good doctors that caught this. All I can say is that every male needs the PSA test, it's just a simple blood test. The VN vets really need to get this test. This is preventive medicine, what is wrong with that??

Posts: 10
Joined: Jul 2012

I read somewhere that almost 100% of all Urologist have an annual PSA test...I'm guessing if they didn't think it was important they wouldn't have it done...I turned 50 had a physical...found my PSA was elevated...turns out I have/had aggressive cancer that was in over 60% of my prostate...It may have saved my life or at least added many years to it.

hopeful and opt...
Posts: 1643
Joined: Apr 2009


Posts: 694
Joined: Apr 2010

ASCO has a 12 page decision aid, written in plain language, for physicians to use with patients to help guide discussions about PSA screening.


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