New Prostate Testing Guidelines Not Followed
Even as guidelines for testing men for prostate cancer are changing, few men are heeding them.
By Stephanie Soucheray
Changing bad health behaviors is hard, but changing health behaviors seen by many as “good” or harmless may be even more difficult.
Take, for example, screening for prostate cancer. For a generation of men, prostate-specific antigen testing (PSA) was a standard blood test performed every year after the age of 50 to check for prostate cancer. It was thought that the higher a man’s PSA level was, the more likely he may have prostate cancer.
But in 2011, the U.S. Preventative Services Task Force issued a recommendation against the test, and earlier this spring the American Urological Association recommended against the test for most men, saying that the risks may outweigh the benefits of the exam.
But new research from RTI International shows that most men still get PSA tests and are not informed by their physicians of the risks and benefits of the exam. RTI’s study, which was published in the American Journal of Preventive Medicine, surveyed 1,089 men between the ages of 40 and 74 who did not have a history of prostate cancer.
The men were presented with the 2011 recommendations and asked if they agreed with them and if they believed the information was based on current data. Most men agreed with the recommendations.
But the study found that more than half the men surveyed (54 percent) planned on getting a PSA screening at their annual doctor’s visit. Thirty percent were undecided.
“The patients we surveyed hardly had providers talk about benefits versus risk to the PSA,” said Linda Squiers, senior health communication scientist at RTI and the paper’s lead author.
Squiers said 70 percent of men surveyed said they did not talk about the risks of PSA testing with their physicians.
Real risks emerging
According to recent research, there are several problems with PSA testing. Even if a man’s elevated PSA levels signal a cancerous tumor, the cancer may be growing so slowly it will not threaten the man’s life. Instead, aggressive treatment may leave men impotent or incontinent.
Moreover, prostate biopsy, often performed after elevated PSA levels are found, can actually increase PSA levels and introduce infection and pain to the patient.
“The risks of PSA testing is a conversation men are still not having with their doctors,” said Gary Schwitzer, publisher of HealthNewsReview.org, a site that grades medical news coverage in the media. Schwitzer is a critic of preventative screening measures that do more harm than good for the majority of patients.
“We turn healthy people into patients. These men are over-diagnosed, and we are taking advantage of the worried well. Turning normal states of health into disease. Changing people’s lives.”
Schwitzer said the PSA test, like the mammogram, is taken at face value as a “good” even when a national council advises against the test.
“A recommendation from some panel doesn’t register with [them],” said Schwitzer. “You can’t overcome years and years of upbringing that screening tests always make sense.”
Schwitzer said he’s not anti-screening tests, but he doesn’t believe they should be mandated. He also said physicians need to have a new kind of discussion with patients about screening tests.
“The current discussion is so imbalanced,” he said. “If we lead everyone to believe that screening makes sense, then anything you find through screening also needs to be treated.”
Squiers said the results of the survey didn’t surprise her, and were reminiscent of the confusion and ambivalence that surrounded mammography after the United States Preventative Services Task Force recommended against them, in 2010, for women under 50. A similar study done recently found women have not changed their habits around getting mammograms after that study was released.
“People want to take preventative measures,” said Squiers.
Main page image courtesy Neeta Lind, flickr creative commons