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Recent recommendations from the U.S. Preventive Services Task Force (USPSTF) advising elimination of routine prostate-specific antigen (PSA) screening for prostate cancer in healthy men are likely to encounter serious pushback from primary care physicians and from many people who simply don't believe that the test is
ineffective.
Even faced with overwhelming evidence, such as a ten-year study of around 250,000 men that showed the test didn't save lives, many activists and medical professionals are clamoring for men to continue receiving their annual PSA test.
The PSA test, causes more harm than good — it leads men to receive unnecessary, and sometimes even dangerous,
treatments.
According to the USPSTF, evidence suggests the potential harms caused by PSA screening of healthy men as a means of identifying prostate cancer outweigh its potential to save lives and that routine annual screening should be eliminated in the healthy. Elevated PSA readings are not necessarily evidence of prostate cancer, and can lead to unnecessary prostate biopsy. In addition, even when biopsies reveal signs of prostate cancer cells, evidence shows that a large proportion will never cause harm, even if left untreated. The disease in older men often progresses slowly so that those who have it frequently die of other
causes.
In a survey of 125 primary care doctors, the researchers found that while doctors agreed with older recommendations to curtail routine screening in men over age 75 and among those not expected to live 10 or more years, a large number said they faced significant barriers to stopping PSA testing in men who had been receiving it regularly. The most frequently cited reason by 74.4 percent of physicians was, “My patients expect me to continue getting yearly PSA tests,” followed by 66 percent of them who said, “It takes more time to explain why I’m not screening than to just continue screening.” More than half of those surveyed in the new study believed that, “By not ordering a PSA, it puts me at risk for
malpractice.”
The survey was conducted in November 2011, right after draft recommendations were made to end routine screening of all men, but before last week, when the draft recommendations were officially
approved.
“It can be very difficult for doctors to break down the belief that all cancer screening tests are invariably good for all people all the time,” says Craig E. Pollack, M.D., M.H.S., an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine, and leader of the study published online in the journal Cancer. “Everyone agrees that PSA screening isn’t as good as we want it to be. If we had a test that was a slam dunk, it would be different. But now we know that for many men, the benefits may be small and the harms
significant.”
Each year, more than 33,000 American men die of prostate cancer, and 20 million get the PSA test to detect the disease
early.
Treatments for prostate cancer can include the removal of the prostate, radiation or other therapies, each of which has the potential to cause serious problems like erectile dysfunction, complete impotence, urinary incontinence or bowel damage. And men who choose to “watch and wait” after elevated PSA readings must live with the anxiety of knowing they have an untreated cancer that could start to progress.
In an article published in Psychological Science, a publication of the Association for Psychological Science, researchers Hal R. Arkes, of Ohio State University, and Wolfgang Gaismaier, from the Max Planck Institute for Human Development in Berlin, Germany, picked apart laypeople's reactions to the report, and examined the reasons why people are so reluctant to give up the PSA test.
"Many folks who had a PSA test and think that it saved their life are infuriated that the Task Force seems to be so negative about the test," said
Arkes.
They suggest several factors that may have contributed to the public's condemnation of the report. Many studies have shown that anecdotes have power over a person's perceptions of medical treatments. For example, a person can be shown statistics that Treatment A works less frequently than Treatment B, but if they read anecdotes (such as comments on a website) by other patients who had success with Treatment B, they'll be more likely to pick Treatment B. The source of the anecdotes matters too. If a friend, a close relative, or any trusted source received successful treatment, they would be more likely to recommend that treatment to others, even if there was evidence showing the treatment only works for a minority of people.
“Men often expect PSA screening to be part of their annual physical,” Pollack says. “To change their minds, we need to address their perceptions about screening, allow time for screening discussions and reduce concerns regarding malpractice
litigation.”
The studies were supported in part by a Maryland Cigarette Restitution Fund Research Grant to Johns
Hopkins.
Other Johns Hopkins researchers involved with the studies included Elizabeth A. Platz, Sc.D., M.P.H.; Nrupen A. Bhavsar, Ph.D., M.P.H.; Gary Noronha, M.D.; Gene E. Green, M.D.; and Sean Chen, B.A.
For more
information:
http://www.hopkinsmedicine.org/gim/faculty/Pollack.html
Association for Psychological Science
(MDN)
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