The American Cancer Society Is Now against Prostate Cancer (PSA) Testing

American Cancer Society Guideline for the Early Detection of Prostate Cancer: Update 2010 was published in the March 2010 issue of CA: a cancer journal for clinicians. Andrew M. D. Wolf, MD and his colleagues decided after extensive meetings that, "The ACS recommends that asymptomatic men who have at least a 10-year life expectancy have an opportunity to make an informed decision with their health care provider about screening for prostate cancer after they receive information about the uncertainties, risks, and potential benefits associated with prostate cancer screening. Prostate cancer screening should not occur without an informed decision-making process. Men at average risk should receive this information beginning at age 50 years."

An accompanying editorial by the Chief Medical Officer of the ACS, Otis Brawley, MD, clarified the Society's change in position over the past years: "The ACS guidelines are neither a statement against prostate screening nor a statement for prostate screening; rather, they are a statement for informed or shared decision making. More clearly than in 1997 and 2001, these guidelines state that there are definite uncertainties regarding the efficacy of prostate cancer screening, there are known risks associated with it, and there may be a benefit...In these guidelines, the ACS has taken a clear position discouraging routine or mass screening and encouraging a discussion within the physician-patient relationship."

Comments: The American Cancer Society has clearly done some soul-searching over their past recommendations, which have been perceived by many as encouraging men to have a blood test to measure their level of prostate specific antigen (PSA). Their change in position followed the publication in March 2009 of two large randomized trials showing the lack of the effectiveness of PSA testing and the harms done. One study published from the US of 76,693 men offered annual PSA testing for 6 years and digital rectal examination for 4 years, or usual care, showed no difference in death rates between the two groups. The second study from Europe of 182,000 men assigned to PSA screening at an average of once every 4 years or to a control group that did not receive such screening found, "1410 men would need to be screened and 48 additional cases of prostate cancer would need to be treated to prevent one death from prostate cancer." In other words, 1410 men would be inconvenienced, worried, and required to spend money, and 48 mens' lives would be dramatically changed by being labeled "cancer victims" and receiving treatments that cause physical pain, urinary leakage, and impotence, in order to save one life (maybe). Of the men diagnosed by PSA testing, aggressive testing and treatments unnecessarily harmed 47 of them because they would never have known they had a problem if doctors weren't busily looking for trouble.

Every day thousands of potential patients and professionals stop betting on this dead horse, the PSA test. Richard J. Ablin, the inventor in 1970 of the PSA test, wrote an op-ed piece titled "The Great Prostate Mistake" for the New York Times on March 9, 2010. He expressed his regrets: "Even then, the test is hardly more effective than a coin toss. As I've been trying to make clear for many years now, PSA testing can't detect prostate cancer and, more important, it can't distinguish between the two types of prostate cancer –the one that will kill you and the one that won't." He continues, "So why is it still used? Because drug companies continue peddling the tests and advocacy groups push 'prostate cancer awareness' by encouraging men to get screened...Testing should absolutely not be deployed to screen the entire population of men over the age of 50, the outcome pushed by those who stand to profit." His apology continued: "I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster."

Because of the huge profits that go to doctors, laboratories, pharmaceutical and device companies, men will continue to be bullied and frightened into getting their PSA levels checked. Most guilty of propagating this test that leads to psychological suffering and physical mutilation of men are the trade unions that represent doctors, laboratories, and drug companies. The American Urological Association (AUA) serving the interest of more than 16,000 urologic health professionals worldwide believes..."that all men, with a life expectancy of 10 years or more, should have a baseline PSA test at the age of 40." A look at their website discloses one big reason for their position. The AUA is supported by makers of prostate cancer drugs, including Pfizer, Eli Lilly, and GlaxoSmithKline, and by manufacturers and suppliers of equipment used to test and treat men. Their vested interests are blatant and so are those of other fronts for industry, such as the American College of Radiology and the Urological Society of Australia and New Zealand.