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NLM Director’s Comments Transcript
Stop PSA Screening?: 06/04/2012

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Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

Here is what's new this week in MedlinePlus.listen

The U.S. Preventive Services Task Force recently recommended PSA blood tests should not be used to screen for prostate cancer in men.

The Task Force (an independent panel of experts authorized by Congress to recommend preventive services for patients) found the PSA test’s risks outweighed its benefits. The Task Force’s recommendations were published and debated in two accompanying editorials in the Annals of Internal Medicine.

In a news release about its recommendations, the Task Force’s co-chair Michael LeFevre M.D., succinctly said (and we quote): ‘…before getting a PSA test, all men deserve to know what the science tells us about PSA screening; there is a very small potential benefit and significant potential harms’ (end of quote).

Specifically, the Task Force found one adult man out of 1,000 may avoid death as a result of a PSA (or prostate-specific-antigen) test for prostate cancer. Yet, the Task Force reported about one man in 3,000 who received a PSA test died prematurely as a result of complications from treatment and about 43 of every 1000 men were seriously harmed.

Most of the serious treatment harms included incontinence, erectile dysfunction or both. The Task Force added there is a small risk of serious cardiovascular complications, such as a heart attack, as well as blood clots in a man’s legs or lungs.

The Task Force based its recommendations on two comprehensive, randomized clinical trials of about 77,000 men in the U.S. and nearly 162,000 men in Western European.

The American Cancer Society reports about 28,000 American men die annually and 242,000 new cases of prostate cancer are estimated to occur this year. PSA blood tests have been a widely used screening tool in checkups for men after age 40.

The Task Force was careful to note its recommendations apply only to the routine prostate cancer screening of men who have not been diagnosed with prostate cancer. The Task Force did not assess the clinical utility of the PSA screening test after a diagnosis or treatment for prostate cancer. In an accompanying editorial, Otis Brawley M.D., the chief medical and scientific officer of the American Cancer Society, explained the Task Force’s recommendations are consistent with a draft released in October 2011 that (and we quote) ‘caused many clinicians and patients to express outrage’ (end of quote).

The second accompanying editorial sharply criticized the Task Force’s recommendations as based on a flawed analysis of existing research. The editorial (which was co-written by nine physicians) immediately noted the Task Force’s expert panel failed to include a urologist or any cancer specialists.

In an overall response to criticisms of the Task Force’s recommendations, Dr. LeFevre told the New York Times (and we quote): ‘Change is hard. It is hard for all of us, both within and outside the medical profession, to accept that not all cancers need to be detected or treated, and that there are harms associated with screening and not just benefits’ (end of quote).

The Task Force’s recommendations seem to reinforce the importance of physician-patient communication about the risks and benefits of prostate cancer screening. The Task Force’s findings also underscore the need for a new, improved clinical alternative to the current PSA test to screen men for prostate cancer. 

Full disclosure: Dr. LeFevre is a professor of family medicine at the University of Missouri-Columbia (MU) School of Medicine; I did some projects with his colleagues when I was on the MU journalism faculty. I vividly recall Dr. LeFevre teaching MU medical students about the value of common cancer screening tests for men and women -- in one of the clearest summaries of biostatistics I have ever heard.

Meanwhile, MedlinePlus.gov’s prostate cancer health topic page covers some of the risks and benefits of PSA, screening, and treatment. A helpful explanation about the risks and benefits of screening (provided by the U.S. Centers for Disease Controls and Prevention) can be found in the ‘prevention/screening’ section of MedlinePlus.gov’s prostate cancer health topic page.

Common questions and answers about the PSA test (provided by the National Cancer Institute) can be found in the ‘diagnosis/symptoms’ section. An introduction to treatment options for men with early-stage prostate cancer (also provided by the National Cancer Institute) can be found in the ‘treatment’ section.

MedlinePlus.gov’s prostate cancer health topic page additionally contains links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to related clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. From the prostate cancer health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.

To find MedlinePlus.gov’s prostate cancer health topic page, type ‘prostate cancer’ in the search box on MedlinePlus.gov’s home page, then, click on ‘Prostate cancer (National Library of Medicine).’

MedlinePlus.gov also contains related health topic pages on: Financial Assistance, Managed Care, Medicaid, Medicare, and Medicare Prescription Drug Coverage.

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A disclaimer – the information presented in this program should not replace the medical advice of your physician. You should not use this information to diagnose or treat any disease without first consulting with your physician or other health care provider. I want to take the opportunity to wish you a very happy holiday season and a healthy New Year. The National Library of Medicine and the 'Director's Comments' podcast staff, including Dr. Lindberg, appreciate your interest and company – and we hope to find new ways to serve you in 2012.

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