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Halting PSA testing the right thing to do, bioethicist says

The recommendation Monday by the prestigious United States Preventive Services Task Force (USPSTF) that the widely used PSA test for prostate cancer no longer be used routinely for men of any age is likely to be met with howling.

There are plenty of doctors who offer PSA testing.  Not a few celebrities, such as former New York Mayor Rudy Giuliani, have made public service announcements urging men to get tested based on their own experience with prostate cancer. 

The true believers are not going to be swayed by this recommendation not to test, despite the fact that the task force carefully reviewed all the evidence on PSA testing. The recommendation against PSA testing is likely to meet the same fate as the earlier task force recommendation against annual mammograms for women in their 40s — disbelief, followed by testing as usual. That is unfortunate.

We all want to believe that early detection of cancer is a good thing.  A large number of doctors are committed to early detection too. But, using a bad test is actually worse than not testing at all.  

The wish for a good test is understandable. Prostate cancer is the second leading cause of death from cancer in men.  If there is a test that can help detect it early then how can that possibly be bad?  And if so many men swear by the test, saying it saved their lives, then what can the USPSTF possibly be thinking in saying men should not bother with PSA testing? 

The answer is that bad tests are bad when they are hugely inaccurate.  The PSA test is an outstanding illustration of this.

PSA testing produces far more misery than good.  Positive PSA tests often are inaccurate, detecting only an infection not cancer. As many as 70 percent of men with poor test scores do not have cancer. This leads to lots of worry and unnecessary procedures for the majority of men who will get a false result. Frequently, unnecessary surgery leads to incontinence, impotence or other nasty complications.

Even when cancer really is present in older men the tumor is usually growing so slowly that leaving it alone makes more sense then undergoing surgery to have it removed.

No man should trust his life to a test that is wrong more often than it is right.  Nor should payers keep paying for a test that does far more harm than good.  It is time to admit that the PSA has flunked and to renew research to find a better test.

More comment from Art Caplan:

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