Cancer Screens: Agreeing to Disagree

Prostate cancer PSA tests preferred by most men in study

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) For years, people have been told that cancer screenings save lives. Recently, though, some organizations have said that some cancer screenings may be more harmful than helpful.

A new study uncovered that most men surveyed wanted to have prostate cancer screenings using the prostate-specific antigen (PSA) test.

These desires for testing are in spite of recent changes in recommendations that the PSA test not be performed for most middle-aged men, changes which many of the men weren’t even aware of.

"Research the risks and benefits of all medical procedures."

Linda Squiers, PhD, senior health communication scientist at the non-profit research institute RTI International in Rockville, MD, was the study’s lead author.

In October 2011, the US Preventive Services Task Force (USPSTF) recommended against most middle-aged men having PSA tests because the risks outweighed the benefits. 

The potential harms of prostate cancer screening include results that falsely suggest the presence of prostate cancer; these false-positives are seen in up to 10 percent of test results, according to the researchers. 

Also, some 100,000 men are treated for low-risk prostate cancer that may never cause problems because it is so slow-growing.

This study was designed to assess men’s knowledge of the USPSTF prostate cancer screening recommendations and intent to follow the guidelines.

A web survey of 1,089 men between the ages of 40 and 74 was conducted in November and December 2011 — just weeks after the USPSTF recommendations came out. The men who answered the survey had no history of prostate cancer.

The survey found that more than 75 percent of the men surveyed didn’t know about the USPSTF recommendations.

When the recommendations were explained, 62 percent of the men reported agreeing with the guidelines. 

The researchers also learned the following:

  • 54 percent of the respondents said that they did not plan to follow the USPSTF recommendations.
  • Only 13 percent of the men surveyed said they intended to follow the USPSTF recommendations, and not take the PSA tests.
  • 33 percent were undecided about whether or not they’d have the tests.
  • 70 percent of participants said they had either not had or did not remember having a discussion with their physicians about the benefits and harms associated with PSA testing.
  • Men most likely to favor PSA testing included African-Americans, men with higher incomes and individuals who had had a PSA test in the previous two years.

"In the past, recommending against cancer screening has caused confusion, as most messages to the general public support cancer prevention and early detection through screening," the authors wrote.

DailyRx News spoke with prostate cancer expert Brian Miles, MD, FACS, about this study. "Men, and certainly my patients, are uncomfortable with the notion of avoiding a test that could easily help them discover whether or not they have prostate cancer. They tend to agree with my thoughts that the issue is not 'should we diagnose prostate cancer,' but 'should we treat it,'" said Dr. Miles.  

"Diagnosing the disease is important in so far as many of the patients are discovered with very aggressive cancers that should be treated. There are others who have lower grade or not very aggressive cancers that can be comfortably watched," said Dr. Miles, who specializes in robotic radical retropubic prostatectomy at Methodist Hospital in Houston, TX.

He continued, "The only way to tell the difference is to of course, detect the patients through biopsy, which is usually directed by PSA testing. The highly at risk population, such as those with a family history or African American males, need to continue to be tested, and as this paper shows, these groups will continue to do so in spite of the USPSTF recommendation," Dr. Miles concluded.

The American Urological Association (AUA) has just released its own set of guidelines. This professional group says it cannot recommend for or against PSA screening for men at average risk for prostate cancer between the ages of 40 and 54.

Men aged 55 to 69 years should discuss screenings with their physicians, according to the AUA.

The AUA also recommends that men who are at high risk of prostate cancer, including African Americans and those with strong family histories of the disease, should discuss screenings with their physicians and make their own decision.

This study was published July 9 in the American Journal of Preventive Medicine

No conflicts of interest were reported.

Reviewed by: 
Review Date: 
July 8, 2013
Last Updated:
August 19, 2013