I recently had an awkward conversation with my doctor. I was getting a routine physical, and he recommended that I get a PSA test for prostate cancer. I told him the PSA test harms more men than it helps. He acknowledged that PSA tests produce false positives, but he insisted that follow-up tests and biopsies will determine whether you really have a life-threatening cancer. He knew someone whose life had just been saved by the test.
When I still declined to get tested, he looked as though he felt sorry for me. He should feel sorry for the millions of men who have gotten unnecessary biopsies, surgery and radiation as a result of taking the PSA test.
PSA stands for prostate-specific antigen, an enzyme produced by the prostate gland, which is located below the male bladder. The test, which was developed in the 1980s, looks for elevated PSA levels, which can indicate cancerous cells in the prostate gland.
The problem is that inflammation and other problems unrelated to cancer can also elevate PSA levels. And when the PSA test correctly detects cancer, it is often so slow-growing that it would never have caused death or even impairment of health. Detection of these non-deadly cancers is called overdiagnosis.
In 2012, the U.S. Preventive Services Task Force, a federally funded panel of experts, recommended against the PSA test, saying the cons outweighed the pros. The decision was based primarily on data from two large studies, one done in the U.S., which found that screening did not reduce mortality, and the other in Europe, which showed a modest reduction.
Last spring the task force upgraded its assessment slightly, based on new data from the European study. The New York Times broke down the statistics behind the new assessment as follows: If 1,000 men ages 55 to 69 get tested regularly for 10 to 15 years, 240 men will receive a positive PSA result, which is usually followed by a biopsy. 100 will receive a positive biopsy result, 80 will receive surgery and/or radiation, and 60 will suffer side effects from this treatment, including incontinence and impotence. One to two deaths from prostate cancer will be prevented.
Just to be clear: you are 240-120 times more likely to misdiagnosed as a result of a positive PSA test and 80-40 times more likely to get unnecessary surgery or radiation than you are to have your life saved. These data are based on a draft document of the task force.
The American Academy of Family Physicians recommends against routine PSA screening, but many physicians, like my doctor, continue to promote them. To understand why, read the important new book An American Sickness by Elisabeth Rosenthal, which reveals how greed has corrupted health care. Rosenthal, who got her M.D. before becoming a medical journalist, notes that the PSA test has created a “huge industry for testing and surgery.”
As an example, she points to urologist David Samadi, who runs a program for robotic prostate surgery at a New York City hospital and is a medical correspondent for FOX News. In 2014 Samadi created “The Samadi Challenge,” which urges women to pester “the men in their lives” to get PSA tests starting in their 40s. Samadi “makes around $3 million a year,” Rosenthal reports.
How can physicians ethically promote tests that cause so much harm? Isn’t that a violation of the Hippocratic oath? And how can consumers allow themselves to be bullied and frightened into getting such flawed tests?
Now excuse me, I need to find a new doctor.
John Horgan directs the Center for Science Writings, which is part of the College of Arts & Letters. This column is adapted from one originally published on his ScientificAmerican.com blog, “Cross-check.”
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