PSA test not recommended by Task Force — but have they gone too far (again)?

The PSA test is an unreliable test that has led to serious overtreatment of prostate cancer. Few argue it's anything but a lousy screen for the second deadliest cancer among American men.

Grading cancer from 1 to 5, the least to the most aggressive

But the U.S. Preventative Services Task Force's recommendation (released next Tuesday, Oct. 11th) that the screen should no longer be given to healthy men is going way too far. (Reuters--PSA Test for prostate cancer not recommended: panel.)  Also read Prostate cancer test under fire.)

They may've over-reached in trying to protect men from the "collateral damage" of radiation and surgical treatments — i.e., varying degrees of impotence and incontinence.

I understand giving guys a "warning" that the test is not cracked up to what everyone may think — but hey, it's still the only game in town for early detection.

First of all, guys in high risk groups, such as those with fathers, brothers and uncles who have had prostate cancer, need to watch for any changes in PSA. No other test exists that suggests the possible presence of cancer. A genetic link can increase the risk of cancer by four times.  Unfortunately, the PSA test is the only test to keep an eye on it.

Prostate cancer is often asymptomatic or expresses the same signs as prostatitis (infection) or BPH (an enlarged prostate).  So don't count on symptoms to tell you that it's arrived.

Secondly, overtreatment is the result of physicians treating nonlethal prostate cancer. Studies have shown that perhaps as much as 50% of all diagnosed prostate cancer fall into this  category.  It won't kill you, you just live with it.

Problem is, science has not developed a screen to distinguish between the lethal and nonlethal varieties.  Therefore, by not taking a PSA test, you're actually gambling that if you develop prostate cancer -- and most men eventually do -- that you will have the nonlethal kind. Which is a coin flip. 50/50.  Heads you win, tails... good luck.

Now, to clear all this up, what the world needs is a prostate cancer screen that identifies the lethal strains, and then we (and our doctors) can make intelligent, prudent decisions about who undergoes surgery and radiation or some other aggressive treatment, and who does not need it.

But to simply say that you or your doctor do not need basic information about possible cancerous changes in your prostate — a rising PSA can SUGGEST cancer — seems to me bad medicine. 

Since my prostate cancer in 2008, I've not been a fan of the PSA test.  As mentioned, it's unreliable.  It leads to false positives. It scares the crap outta guys unnecessarily, and leads to abusive use of biopsies, which is no fun. 

Almost worst than a biopsy, physicians have used the screen to justify unnecessary radical treatments (and benefit financially) -- again, because there is no way to distinguish between lethal and nonlethal prostate cancer. 

Look, I hate the PSA test but I'd still have it -- especially if prostate cancer is in the family.  That way,  at least I had the knowledge of any significant changes in my prostate, particularly in the 40s, 50s and 60s when prostate cancer TENDS to be more aggressive. If levels become elevated, you and your doctor(s) can decide what is best for you, including choosing active surveillance.

The lethal strain of prostate cancer is a nasty cancer that can get in your bones and become very painful... not to mention, it's also the second leading cancer killer among American men.

The Task Group may be determining that the PSA test is doing more harm than good, but maybe the harm is more related to medical decisions made after the test (and after a biopsy result), rather than the test itself. 

It's tricky. All of this points to the importance of a new and more reliable screen.

I have a feeling this Task Group is gonna take a lot of heat in the coming days.  Basically, they're recommending that men opt to do and know absolutely nothing until it may be too late -- what is that?  It's just being willingly stupid.

The Task Group has just gone too far.

Weighing all this, remember the U.S. Preventative Services Task Force is the same group that recommended that doctors scale back on routine mammograms for women in their 40s and 50s.  That didn't go over well either with the early detection crowd -- I expect more of the same with the men.

***Another good article to read by MedPage Today.