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Tampa Bay experts expect more confusion over prostate test advice

Stan Good, 65, of Tampa found out he had prostate cancer nearly two years ago after having PSA testing. He’s now cancer-free. “I’m breathing because somebody did a PSA on me,” Good said.

EDMUND D. FOUNTAIN | Times

Stan Good, 65, of Tampa found out he had prostate cancer nearly two years ago after having PSA testing. He’s now cancer-free. “I’m breathing because somebody did a PSA on me,” Good said.

TAMPA — Many men and their doctors won't find clear answers in new guidance that a widely used screening test for prostate cancer isn't necessary — and may be doing more harm than good.

A draft recommendation by the U.S. Preventive Services Task Force, an influential panel of independent experts, found that the PSA blood test doesn't save lives overall when used as a routine screening test.

The official release is this week, but already the report is stirring ripples around the Tampa Bay area and across the nation.

The guidance, based on a review of scientific studies in the United States and abroad, marks the strongest statement yet against PSA testing, which long has been debated. But for men who are regularly tested, it could create as much confusion and controversy as the same task force's 2009 recommendation that most women in their 40s shouldn't get routine mammograms.

"It's as emotional as breast cancer," said Dr. Julio Pow-Sang, a urologist and chair of the department of genital urinary oncology at Moffitt Cancer Center in Tampa. "Many prostate cancer groups are going to come out and criticize the task force for giving this recommendation."

More than 200,000 American men were diagnosed with prostate cancer last year; about 3 percent of men are at risk of dying of prostate cancer in their lifetime, most after age 75.

But while the PSA test is good at finding prostate cancer, it can't distinguish between deadly cancers and those that will never cause health concerns. Getting an elevated PSA reading often leads to more tests and treatment, which can result in incontinence and impotence.

About one in six U.S. men will be diagnosed with prostate cancer at some point in their life. Yet the American Cancer Society notes that in Western European countries where screening isn't common, one in 10 men are diagnosed and the risk of death on both sides of the Atlantic is the same, illustrating the concern about overtreatment in the United States.

"There are some men that definitely are going to benefit from treatment, but we don't know who those men are," Pow-Sang added. "That is the elephant in the room."

Pow-Sang, who had a baseline test at age 50, advises patients to become educated about the risks and benefits of the PSA test.

As the debate over PSA testing has heated up, leading medical groups are offering contradictory advice. The American Urological Association says PSA screening should be offered to men beginning at age 40.

The American Cancer Society — which recommends routine mammography after age 40 — is less enthusiastic about the PSA.

"It has been very apparent for some years that some supporters of prostate cancer screening have overstated, exaggerated and, in some cases, misled men about the evidence supporting its effectiveness," said Dr. Otis Brawley, chief medical officer at the American Cancer Society, who would not comment on the task force's recommendations.

Many prostate cancer survivors, however, see the test as an absolute lifesaver. It may not be possible to know whether a cancer will grow into a killer, but plenty of men don't want to even consider the "watchful waiting'' approach some advocate.

PSA testing picked up on Stan Good's prostate cancer almost two years ago. After hormone and radiation treatment, the 65-year-old Tampa man considers himself lucky to be cancer-free.

"I'm breathing because somebody did a PSA on me," Good said, acknowledging the trade-off in his quality of life.

While he isn't impotent, his sex life isn't what it used to be. "(But) I will take a somewhat reduced sex life over death any day," he added.

Yet other patients are questioning their doctors' advice to get tested and subsequently treated for prostate cancer.

"When these (PSA) articles come out every few years, people come in whom I've diagnosed, treated and cured. And they will say to me, 'You know what doctor, you probably didn't have to treat me,' " said Palm Harbor urologist Jerrold Sharkey. "That's terrible for me to hear."

He noted that some of the studies upon which the new recommendation is based have been criticized for design flaws, even though they may represent the best evidence available.

He will keep recommending PSA testing, especially for men with a family history of the disease and for African-Americans, who are more likely to die of prostate cancer.

"Yes, they should be educated consumers. And yes, they should question their doctor about whether they need treatment," said Sharkey, who gets tested annually himself. "But that doesn't mean they should put their head in the sand and say they shouldn't get a regular PSA, like a woman gets a mammogram."

Undoubtedly, such concerns will be aired when a public comment period on the report begins. And politicians will likely weigh in, as the task force's recommendations can influence what Medicare — and then private insurance — will cover.

So, men should brace themselves for confusing and contradictory advice from leading experts and their own doctors.

"You have a great deal of anxiety in people," said Dr. Frank Mastandrea, a urologist in private practice with Florida Urology Partners in Tampa and who is affiliated with St. Joseph's Hospital in Tampa. Mastandrea, for his part, has the test, and recommends his patients to have it as well.

"We need science to lead the way, not politics."

Information from Times wires contributed to this report. Letitia Stein can be reached at 727-580-1866 or lstein@sptimes.com.

About the task force

The U.S. Preventive Services Task Force is a 16-member panel of doctors and nurses that regularly assesses preventive medical care. It is chaired by Dr. Virginia Moyer of the Baylor College of Medicine. Its recommendations, independent of the federal government, are guided by science, not cost.

Members are chosen by director of the Agency for Healthcare Research and Quality. They represent experts in internal medicine, family medicine, pediatrics and obstetrics/gynecology.

To learn more: uspreventiveservicestaskforce.org.

Tampa Bay experts expect more confusion over prostate test advice 10/08/11 [Last modified: Saturday, October 8, 2011 11:54pm]
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