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PROSTATE CANCER SCREENING:
A NEW "AUTHORITATIVE" REPORT

(March 2003)

Healthful Life has maintained that we do not know how to prevent prostate cancer and screening with the blood test called prostate specific antigen (PSA) or with the digital rectal examination has not been shown to save lives or prolong good quality life. We do not recommend the test - and we will not until the two major studies, one in the United States and one in Europe, now in progress, give us a definitive answer as to whether doing PSA testing does or does not save lives or significantly prolong life.

On December 8, 2002, the well-respected US Preventive Services Task Force reported its new recommendations in the Annals of Internal Medicine. This was accompanied by a lot of media coverage. One headline declared "Government drops objection to prostate test". Another said "panel softens prostate screening stance". In 1996, the panel had given the PSA test a "D" rating, meaning the evidence suggested the test should not be done.

Here is what the Task Force said. "No conclusive direct evidence shows that screening reduces prostate cancer mortality. Although potential harms of screening for prostate cancer can be established, the presence or magnitude of potential benefits cannot. Therefore, the net benefit of screening cannot be determined."

"Screening is associated with important harms, including frequent false-positive results and unnecessary anxiety, biopsies, and potential complications of treatment of some cases of cancer that may never have affected a patient’s health. The Task Force concludes that evidence is insufficient to determine whether the benefits outweigh the harms for a screened population."

"The Task Force concludes that the evidence is insufficient to recommend for or against routine screening for prostate cancer using PSA or digital rectal examination."

There you have it. In 1996, the Task Force said do not do it, in 2002, they say we do not know whether screening is beneficial and the harms may outweigh any benefits.

In essence, the Task Force and Healthful Life are in agreement, but the advice for doctors and the public by the Task Force and other organizations in writing and in media interviews is sort of strange. They recommend doctors inform men of the "gaps in knowledge", "assist men in their personal preferences" (consider mens’ personal preferences). What those difficult to interpret phrases really mean, as stated more clearly in interviews, is that men should be given the confusing information and be urged to educate themselves so they can make an "informed" decision about undergoing the PSA test, thus relieving the doctors of responsibility for those decisions. So, the men are supposed to review the conflicting articles, interpret the epidemiology findings and the complex statistics, and then decide whether to undergo PSA tests.

If the US Preventive Services Task Force cannot find benefit and can find harms from screening, they and other organizations should, like Healthful Life, just say we do not recommend the PSA test and they should not pass the burden to men to make an "informed" decision.

A few final points.