Mixed reactions on new recommendations for prostate test

Physician reactions are mixed regarding a new recommendation from the U.S. Preventative Task Force not to use a blood test to routinely screen healthy men for prostate cancer.

Some doctors are praising the task force's recommendation not to use the Prostate-Specific antigen blood test to routinely screen healthy men for prostate cancer. Other physicians believe it's too soon to shut the door on widespread screening.

Dr. Badrinath Konety had been expecting some revision to the guidelines for PSA screening. The University of Minnesota urologist said widespread concerns about overtreatment of non life-threatening prostate cancers are valid, especially considering the risks of unnecessary biopsies, surgery or radiation.

But he was surprised that the U.S. Preventative Task Force was so absolute in its recommendation that no healthy male should get a routine PSA test.

"I agree with some of the points they're making," Konety said. "But I also am not sure that the current state of the data that's out there supports the strength of their recommendation."

The task force analysis examined five large PSA screening trials. The two largest trials were conducted in the U.S. and in Europe.

Konety, who also is director of the Institute for Prostate and Urologic Cancers at the university, said while the U.S. trial showed no survival benefit to the PSA test, the European trial did show a benefit for a subgroup of men aged 55 to 69 after nine years.

To Konety, it made sense to explore possible differences in long-term survival more thoroughly before issuing new guidelines.

"If you wait 13, 14 years the difference really becomes even wider," he said. "We're basing a lot of the recommendations on the large studies with reports at ten years and seven years."

But the evidence against routine screening is strong enough to change the practices of Dr. Dave Bucher, a family physician at United Family Medicine in St. Paul.

"I've actually been moving in this direction for about the last six to 12 months and having conversations with my male patients who are in for physicals about what are the risks and benefits," he said.

"It's actually kind of a relief to get the Preventative Services Task Force on the side of evidence-based care."

Bucher said most of his patients accept the advice not to screen if they're healthy, but patients who have had their PSA checked regularly over the years are a little more uncomfortable with halting the test.

If the task force recommendations are adopted, it's still not clear what effect the guidelines will have on patients' decisions to get a PSA test.

Two years ago, the same task force recommended against routine mammograms for women age 40 to 49, prompting outcry from breast cancer survivors and their political allies. That protest prompted Congress to insert language in the federal health care reform law asking insurers to continue to covering routine mammograms for that age group.