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Anytime the medical community casts doubt on cancer screening methods, people get understandably alarmed. It happened two years ago when a government health panel recommended against mammograms for women in their 40s. Well, now that same group, the U.S. Preventive Services Task Force, is recommending against a blood test for prostate cancer. It says healthy men of all ages should not get the PSA test because scientific studies have proven there's no benefit to the screening.
Dr. Timothy Wilt is a member of that task force. He's an internist and a professor at the University of Minnesota School of Medicine. I asked to explain what's wrong with the PSA test.
DR. TIMOTHY WILT: Men often think it's such a simple blood test, but it's the downstream consequences of that. So if the test is abnormal, men undergo biopsies. Biopsies can result in pain, infection, inflammation. And the most important problem is that it can detect cancers that are small, slow-growing and would never cause problems in a man's life.
But because when a man is diagnosed with cancer, it's hard for us to determine which one of those are potentially bothersome. And the vast majority of those are not. But almost all men, about 90 percent of the men who are found to have prostate cancer due to PSA testing undergo treatment for prostate cancer. And prostate cancer treatments have real harms.
BLOCK: And what are the harms that you're talking about that might result from the treatment?
WILT: The harms include about 5 out of 1,000 men will die within one month of prostate cancer surgery, due to the surgery. About 10 to 70 men in 1,000 will have a serious complication from surgery. And those include a heart attack, a blood clot or surgical complications. And while those are relatively uncommon, other side effects such as urinary, bowel and sexual dysfunction are quite common - somewhere between 20 to 30 percent of men - and those often persist for a long period of time.
BLOCK: Would it be fair to say, Dr. Wilt, that the problem isn't so much the initial PSA test itself, it's the problem of what follows, the treatments themselves that can be risky or have these complications?
WILT: That's true. The PSA blood test itself is just a blood test. But it starts a cascade of events that are very difficult for clinicians and patients to close their eyes to. And so, the harms related to PSA screening appear to outweigh the benefits.
BLOCK: Dr. Wilt, prostate cancer, I gather, is the second most-common form of cancer in men after skin cancer - something like 240,000 new cases every year. I was reading the comments from a man named Skip Lockwood, who heads an advocacy group called Zero. And he says that the panel's decision here, in his words: Condemns tens of thousands of men to die.
How would you respond to Mr. Lockwood and advocates such as him?
WILT: Yeah, we appreciate the sincerity of individuals who believe that a PSA blood test has prolonged their life. But the common belief that it does is not supported by the scientific evidence. What we know from the good medical science is that PSA testing does not reduce prostate cancer deaths or help a man live longer.
BLOCK: I wonder if a recommendation like this, against testing, sort of bucks the feeling that many of us have, which is that we want to know what's going on inside of us, we want to be tested, we're used to a lot of testing.
WILT: I think it's often difficult for individuals to understand that some screening tests may not be useful and can actually be harmful. And our recommendations are intended to inform physicians, to allow them to help make the best discussions with their patients to improve their health and well-being.
That's what I do with my patients all the time. I tell them, let's talk about whether this PSA blood test can help make you live longer and live better. And what I'll tell them is that I recommend against it. And most of them are very, very fine with that.
Others will say, you know, Doctor, I'd still like to get that PSA blood test. And I say, let's do that. Let's talk about the results. Let's work and see what we can do based on those results, where we go from here.
BLOCK: The fear there are though would be that if a panel such as yours recommends, or issues guidance against these tests, that insurers may not cover the cost of the test, Medicare might not cover it.
WILT: Our recommendations don't consider cost and are not intended for health insurance coverage. In fact, Medicare currently, by law, covers the PSA blood test. Our recommendations focus on the clinical science intended to try and help men and their physicians balance of benefits and harms of prevention and help promotion strategies.
BLOCK: Dr. Wilt, thank you for your time.
WILT: Thanks so much for your interest.
BLOCK: That's Dr. Timothy Wilt. He's a professor at the University of Minnesota School of Medicine. And he's a member of the government health panel that has issued a draft recommendation against the PSA blood test for prostate cancer.
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