MU professor hears reaction after panel's prostate cancer screening recommendation

Wednesday, May 23, 2012 | 7:11 p.m. CDT; updated 9:07 p.m. CDT, Wednesday, May 23, 2012

COLUMBIA — A recommendation announced Monday that men forgo routine prostate cancer screenings has drawn both gratitude and rejection.

"I think we're seeing the full spectrum of responses that you might anticipate," said Michael LeFevre, vice chairman of MU's Department of Family and Community Medicine. LeFevre is also co-vice chairman of the U.S. Preventive Services Task Force, the group that made the recommendation.

Urologists and prostate cancer survivors have shown special concern about the recommendation, LeFevre said.

"It's hard for doctors and patients both to accept that not all cancers need to be detected or treated," LeFevre said. "It's especially hard when so many personal stories seem to contradict the science."

The task force concluded that there's little if any evidence that a blood test known as PSA testing saves lives. Instead, it announced that too many men suffer impotence, incontinence, heart attacks and occasionally death from the treatment of tiny tumors that never would have killed them.

"The studies show that there are very, very small benefits and significant harms, and that's what a man should understand if they're going to get a PSA done," LeFevre said.

Too much PSA, or prostate-specific antigen, in the blood only sometimes signals prostate cancer is brewing. It also can mean a benign enlarged prostate or an infection. Only a biopsy can tell.

Columbia urologist Michael Cupp of the Urology Associates of Central Missouri called PSA testing one piece of the puzzle in assessing a man's risk of prostate cancer. The test's contribution, though far from exact, is still necessary, Cupp said.

According to the National Cancer Institute, the U.S. death rate from prostate cancer fell by an average of 3.7 percent per year between 1994 and 2009. Cupp attributed the decline to early detection from PSA testing.

"Prior to PSA testing, because we had only the rectal exam, most prostate cancers were fairly advanced by the time we found them," Cupp said. "So the mentality of treatment was fairly aggressive."

After PSA testing became more prevalent, urologists became more comfortable with active surveillance of low-risk diseases such as prostate cancer, Cupp said.

This need for less aggressive treatment nearly closely falls in line with what the task force is recommending. The point of contention, however, comes from the task force's interpretation that the PSA's negatives outweigh its positives. Many urologists, including Cupp, disagree with this interpretation.

The 16-member task force has no urologists or oncologists on its panel and based its decision on a review of statistics from published scientific research.

This does not reflect the experience of those working with prostate cancer on a daily basis, Cupp said.

LeFevre sees it differently. "It's actually ideally suited to make an unbiased judgment about what the science tells us about screening without preconceived notions or conflict of interest," he said.

Both men said the ultimate goal is to inform patients so they can make an independent decision to receive the PSA test.

Among men, the American Cancer Society recommends that discussion about testing begin at age 50. High-risk patients might want to begin testing earlier. The decision includes factors such as race or family history. Whether to get the test should be a conscious decision made by the patient, LeFevre said.

Cupp said he recommends checking PSAs. "But I would not begrudge any person that chooses not to have it tested," he said. "I think it is a personal choice, but it needs to be a choice made on good information."

Recently, more patients have come to him with questions about PSA testing and prostate cancer, he said.

Most men will get prostate cancer if they live long enough. Each year, some 240,000 American men are diagnosed with it, most with slow-growing tumors that carry a very low risk of morphing into the kind that can kill.

The Obama administration said Monday that Medicare will continue to pay for PSA screenings, a simple blood test. Other insurers tend to follow Medicare's lead. 

The Associated Press contributed to this report. 

Supervising editor is Elizabeth Brixey.

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Cecil Caulkins May 24, 2012 | 7:52 a.m.

About 5 years ago, a HS classmate of mine (we were 67 then) was found to have prostate cancer (detected a little late, I thought), and he had a prostatectomy. Too late, as it turns out, because the cancer came back, was very aggressive, and killed him within 18 months. I have a PSA test every year as part of an annual physical and plan to keep it up.

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