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Many men plan to ignore PSA test guideline

Updated: July 9, 2013 03:02 PM
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By Randy Dotinga
HealthDay Reporter

TUESDAY, July 9 (HealthDay News) -- Most older American men plan to get screened for prostate cancer despite a recent recommendation that many should just skip the controversial PSA test, a new survey suggests.

The authors of a report about the survey don't reveal which side of the debate they're on, although they do write that new PSA test research suggests that its "harms outweigh the benefits."

Overall, the survey shows that "we need to do a better job of presenting both the benefits and harms of screening to all patients," said report lead author Linda Squiers, a research and evaluation methodologist with RTI International, in Research Triangle Park, N.C. "We also should explain the science behind the recommendation in plain language so everyone can understand it."

At issue is a 2012 recommendation by the U.S. Preventive Services Task Force regarding prostate cancer screening. It now says men of all ages who haven't been diagnosed with prostate cancer shouldn't get the prostate-specific antigen (PSA) test. The guideline "is based on science and rooted in the knowledge that while everyone wants to help prevent deaths from prostate cancer, current methods of PSA screening and treatment of screen-detected cancer are not the answer," the USPSTF website states.

Critics of the test say it often picks up signs of prostate cancer that are not dangerous, potentially leading to unnecessary and harmful treatment. "You'll often find disease that isn't aggressive and will never harm you. But your doctor, your wife, your relatives will put you under pressure to treat that cancer," said Andrew Vickers, an attending research methodologist at Memorial Sloan-Kettering Cancer Center, in New York City.

Prostate cancer treatment can lead to incontinence and impotence. But, of course, treatment can also prevent death from the disease.

Some physicians say the test is useful, and many continue to give it to patients, in some cases without consulting them.

For the new report, researchers used an online survey to tell 1,089 men aged 40 to 74 about the task force recommendation -- it was in draft form at the time of the survey in 2011 -- and ask them if they planned to follow it. None of the men had been diagnosed with prostate cancer.

The researchers then adjusted the results, adding more or less weight to certain answers in order to better reflect factors such as the nation's mix of age, race and education.

Only 13 percent of the men planned to follow the recommendation and not get a PSA test. Fifty-four percent said they'd ignore the recommendation and get tested, while one-third of men were undecided, the investigators found.

Blacks, wealthier men, those who'd had a recent PSA test, and those who were at least somewhat worried about prostate cancer were more likely to plan to get a test.

Why are many men ignoring the recommendation even when they're told about it? "It is wishful thinking by the men and urging by their physicians that causes the problem," said Dr. Anthony Miller, professor emeritus of epidemiology at the University of Toronto's Dalla Lana School of Public Health.

For his part, Vickers, the methodologist at Memorial Sloan-Kettering, said men seem to have a "misapprehension" about the value of the test and the risk of unnecessary treatment. "Many people think 'If I don't get screened, I will die of cancer. But if I do get screened, I won't,'" he said.

The best approach is to let patients make the call about PSA tests, he said, after making sure they're well informed about the benefits and risks.

The report appeared online July 9 in the American Journal of Preventive Medicine.

More information

Visit the U.S. Preventive Services Task Force to see its recommendation on prostate cancer screening.

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