The two principal studies quoted in the report are the prostate, lung, colon, and ovarian screening study (PLCO) and the European randomized prostate cancer screening study. Both studies compared men who were screened to those who were not screened over a 7-10 year period. The European study actually revealed an improvement in survival whereas the American study did not, thus reporting conflicting results.
One of the many concerns raised by prostate cancer experts and advocates is related to the fact that most of the studies cited in this report had a notable lack of representation of African-American men. Additionally, in the absence of PSA-based early detection strategies, the incidence of advanced disease would certainly increase. In the pre-PSA era, most men who presented with prostate cancer were symptomatic at diagnosis and had evidence of metastatic disease (in other words the cancer had already spread).
Although the overall death rates associated with prostate cancer have begun to decline, African-American men still carry a disproportionately higher death rate. Those under the age of 60 are 4 times more likely to have metastatic disease at diagnosis. The report minimizes the impact of metastatic disease stating that it is unlikely to result in death. However, metastatic disease can have tremendous impact on quality of life including chronic pain, pathologic fractures, paralysis, bleeding, and other tragic consequences.
It is also striking that none of the task force committee members have specific clinical expertise in treating prostate cancer. This attempt to apply a broad-sweeping policy to a very complex disease affecting populations disproportionately is very short sighted.
The bottom line is that fewer men are dying of prostate cancer and it is very likely that early detection has played a role in this outcome. Although the PSA test cannot take all the credit, it has been the cornerstone for early detection over the last 2 decades. There is ongoing research to find better screening strategies. However, until these tests have been confirmed, PSA is an important part of early detection and should not be blatantly discarded, especially as it applies to high-risk populations such as African-American men.
Any man interested in having a PSA test should have meaningful dialog with his health-care provider to understand the details of the test, it's value, and possible shortcomings. That should have been the message from the report. I hope that health-care providers involved in prostate cancer care will respond strongly to these recent recommendations.
For more info on prostate cancer go to http://cancer.howard.edu
Dr.Chiledum Ahaghotu is Associate Professor of Surgery and Chief of Urology at Howard University Hospital