UC Irvine urologists disagree with new prostate screening guidelines

May 23, 2012

Dr. Thomas AhleringDr. Atreya DashDoctors from UC Irvine’s Department of Urology are taking issue with the revised prostate cancer screening guidelines issued this week by the U.S. Preventive Services Task Force, which calls for eliminating the PSA blood test as a screening tool for most men.

A rising level of PSA, or prostate-specific antigen, can be an indication of a tumor.

“The recommendation to discontinue screening in patients 75 or older may be reasonable but to recommend against screening altogether is, I believe, throwing the baby out with the bath water,” says Dr. Atreya Dash. “The test is imperfect – good sensitivity in detecting cancer but poor in predicting who has an aggressive tumor – but it may be appropriate for many patients in the context of their overall health.”

It’s still up to the doctor to describe the pros and cons with each patient, Dash says.

“The task force’s rationale is not that it’s a bad test,” Dash says. “But that the risks of treatment may outweigh the benefits.”

Dr. Tom Ahlering points out that some of the studies the task force reviewed in reaching its recommendation were flawed – similar to comparing apples to oranges.

Ahlering thinks that waiting until symptoms appear before seeking treatment would not be acceptable to most Americans.

“If the U.S. fully followed these guidelines and abandoned PSA testing, we would go back to 1988 – before PSA – when men presented with bone metastasis (40 percent of the time) or extensive urinary complaints (another 40 percent),” he says. “In 1990, annual prostate cancer deaths were about 43,000 and by 2010 that would have risen to 50,000 or 60,000 men.”

With PSA screening, deaths per year are now about 28,000, he says.

“There is no question that PSA has profoundly impacted the mortality from prostate cancer.  Is it a perfect test? No.  But rather then discarding it we need to continue to refine and better screen who will benefit from PSA tests and at what intervals,” Ahlering says. “We also need to work on methods of treating prostate cancer more efficiently with fewer side effects and in a financially sound fashion.”

About 16 percent of men will receive a prostate cancer diagnosis in their lifetimes, and 2.8 percent will die of it, according to the National Cancer Institute. Seventy percent of prostate cancer deaths occur in men over age 75.

The U.S. Preventive Services Task Force recommendations ›