• PSA testing guidelines: NBC's Robert Bazell answers readers' questions

    By Robert Bazell, NBC News correspondent

    Your comments on my Monday posting about the task force’s recommendations on PSA testing are greatly appreciated. 

    They were lively, for the most part civilized, and illustrated the complexity of the subject. As the physician in our "Nightly News" report said, “This has been one of the most gut-wrenching aspects of medicine.”

    In response to what many people said I want to repeat that these are recommendations made for the entire population based on what the panel sees as the best evidence.  They are intended to serve as a starting point for a conversation between a man and his physician. They are not an absolute declaration about what any one person should do about his health care.

    To answer some questions that were raised:

    • Some people asked about how the guidelines apply to younger men.  There were no specific recommendations for younger men.  The two big studies of the efficacy of routine testing were done in men in their 50s, 60s and 70s.
    • Some asked about guidelines on what to if prostate cancer is detected.  The task force did not discuss that issue.  The panel certainly made no recommendation against treatment.  But its mandate was to assess the utility of routine screening of healthy men.
    • As for the question of whether prostate cancer is potentially life threatening, despite Gleason scores and other methods for staging prostate cancer, the issue remains difficult.  Much research is being directed at trying to find a molecular marker that would indicate which prostate cancer poses the greatest threat.
    • Others asked why false positives are a bad thing.  False positives -- or in the case of the PSA test even some not-false positives -- can lead to unnecessary treatment, which can have serious side effects.

    Click here to read Robert Bazell's earlier piece about the PSA test guidelines. 


  • FAQ about the new PSA test recommendations

    A federal panel issued a grade of 'D' to the commonly used prostate cancer screening test, concluding that it does more harm than good. But the American Urological Association disagrees. NBC's Robert Bazell reports.

    By Robert Bazell, NBC News correspondent

    Today a federal health panel issued a report stating that routine screening for prostate cancer may lead to more problems for men than it's worth, including over-treatment, complications and side-effects, even as many cancer survivors say the prostate-specific antigen (PSA) blood test saved their lives. 

    For those who want more information on today’s decision, I've posted answers to some of the most frequent questions I've encountered while reporting the story. If you have a question that isn't answered below, ask it in the comment section, or visit my Facebook page. We will accommodate as many questions as possible and post the answers later this week. 

    What is this panel that made the recommendation about the PSA test?

    This answer can be found on the panel’s website: Created in 1984, the U.S. Preventive Services Task Force (USPSTF or Task Force) is an independent group of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, or preventive medications. The USPSTF is made up of 16 volunteer members who come from the fields of preventive medicine and primary care, including internal medicine, family medicine, pediatrics, behavioral health, obstetrics/gynecology, and nursing. All members volunteer their time to serve on the USPSTF, and most are practicing clinicians.

    Do the recommendations have the force of law?
    No.  Though the USPTF is financed by the federal government, no federal agency, private insurer, or medical provider is required to follow the recommendations.

    Why did the panel give a 'D' grade to the PSA blood test?
    The panel concluded that on the basis of available evidence, the harms of routine use of the test to detect the possibility of prostate cancer in men outweigh the benefits. It gave the PSA test a 'D' grade.

    What does this mean about my individual medical care?
    The panel and almost all experts say the decision of whether a man should have the test should follow a conversation between the man and his doctor.  The panel’s summary of evidence is intended as a starting point for that conversation.

    How could a test for a common cancer end up being not recommended?
    The heart of that answer is that prostate cancer is very different from other cancers.  In some cases it can be a killer.  But very commonly men have it and it is no threat to their lives.  Doctors have little ability to differentiate between the two kinds.  The panel found that 90 percent of Americans who are diagnosed (more than 240,000 this year) end up being treated with surgery, radiation, hormones or a combination.  The reason for that is that when patients and doctors hear the world “cancer,” they often believe they have a life-threatening illness that must be treated immediately.  But treatment often causes serious side effects, so millions of men have been treated who would have lived long, healthy lives without any treatment.

    But I got a PSA test, then a biopsy and then treatment and I believe the sequence of events saved my life?
    It may be true. Millions believe that, but in most individual cases there is no way to know what would have happened if you did not get treatment. The panel’s conclusions are based on studies of populations, not on individual cases.

    Hasn’t the death rate from prostate cancer fallen since the introduction of the PSA test?
    It has and most experts believe the PSA test has played a big role.  But the questions is whether that drop in the death rate is worth all the men who the statistics show have gotten unnecessary treatment.

    Wouldn’t the solution be for men to get tested and wait to see if they actually need treatment?
    Many experts advocate such an approach which used to be called “watchful waiting” and is now called “active surveillance.”  The problem is that experience has shown that the word “cancer” causes such anxiety that many men will not wait.  Also doctors are often trained to – and benefit financially from – performing procedures.

    More information can be found in the following links to papers published today in the Annals of Internal Medicine.  The first is a summary for patients.  The second is the entire report from the task force.  The third is an article supporting the recommendations.  The fourth is an article opposing them.  

    Summary for patients: http://www.annals.org/content/early/2012/05/21/0003-4819-157-2-201207170-00464.full.pdf+html

    Screening for Prostate Cancer: U.S. Preventive Services Task Force Recommendation Statement: http://www.annals.org/content/early/2012/05/21/0003-4819-157-2-201207170-00459 

    Prostate Cancer Screening: What We Know, Don't Know, and Believe
    http://www.annals.org/content/early/2012/05/21/0003-4819-157-2-201207170-00460 

    What the U.S. Preventive Services Task Force Missed in Its Prostate Cancer Screening Recommendation
    http://www.annals.org/content/early/2012/05/21/0003-4819-157-2-201207170-00463