“I was just the regular guy who did just about everything you wanted to do. The last thing I thought they’d say is that I have prostate cancer,” said Kelsey, who is currently in treatment at MD Anderson Cancer Center in Houston and expects to be cancer-free soon. “If not for that test, this probably would have spread outside my prostate within a few years.”
Even if doctors and patients ignore the task force recommendation, insurance companies often turn to the panel for guidance on which preventive services they should cover. In this particular case, most insurers have stated they will continue paying for the PSA tests, but Concepcion worries that the influential position could lead to an eventual reversal of that decision — especially in an era of cost-cutting.
A second, longer trial in Europe, demonstrated a 20 percent drop in the relative risk of prostate cancer-specific deaths. But that trial wasn’t without its flaws either. When a Swedish center with abnormally good outcomes was excluded, the positive results vanished and the PSA tests seemed to have little impact.
“Changing a practice takes time. There’s an old saying that it takes 17 years for medicine to change with a new idea,” Lichtenfeld said. “But I do think that the discussions between doctors and patients will tilt toward a more balanced one as opposed to everyone automatically assuming this is a great test everyone should have every year.”
For one thing, few would argue the test is perfect. While high PSA numbers can throw up a red flag about truly dangerous cancer, they can also indicate a number of other, far more common things – a vigorous bike ride, an infection or recent sexual activity. The only way to determine whether it’s cancer is an uncomfortable biopsy through the rectum, a procedure that results in fever, infection, bleeding or temporary urinary difficulty in 68 of every 10,000 cases, according to the task force.
“But the truth is we didn’t start using this test because we had clinical trials that showed it worked — we started using it because it was around and we were told it saves lives,” he said. “There’s nothing to indicate that was true. Looking back, I’m forced to realize that perhaps some men were benefited and some were not. And for a physician, that’s a difficult thing to accept.”
Barry worries “that we’ve oversold screening,” he said. The popular belief that it’s better to catch cancer — any cancer — early and treat it until it’s gone might just be plain wrong, he said.
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To many men, any amount of discomfort or risk would be worth it if it meant they’re less likely to die of cancer. But it’s not entirely clear that’s the case. Many prostate cancers are slow-growing and would never cause serious harm during a man’s natural lifetime. It’s hard, Barry said, to look at prostate cancer and determine whether it’s deadly. “So they’re all treated,” he said. And those treatments can cause some substantial side effects — impotence, incontinence, even death.