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Florida rejects advice to scrap routine PSA tests

Leading urologists in Florida say they’re disappointed with a government panel’s advice against routine prostate-cancer screening. 

"That’s the wrong message,” objects Dr. Johannes Vieweg, chair of the urology department at University of Florida. The president of an association for Florida urologists said he felt the same way.

The U.S. Preventive Services Task Force, which issued the controversial guidelines Monday, said routine screening of men through blood tests doesn’t really save lives because most of the cancers they uncover involve minuscule tumors growing so slowly they would never have been a bother.

Yet 90 percent of patients who get the diagnosis will be treated with surgery or radiation, leaving many impotent, incontinent or even, in rare cases, dead from a heart attack, stroke or blood clot.

The harm so outweighs the benefit that routine screenings for men of 50 or older should be scrapped, the Task Force said. Earlier guidelines had already discouraged routine screening for men age 75 and older. (Editor's note: The original version of this article misstated the age recommended in previous guidelines.) 

Vieweg said that while mass screenings at community sites aren’t a good idea, it's a different matter when a man discusses discusses the risks and benefits of testing with his own doctor. He noted that some men are at greater risk than others.

Also unhappy with the Task Force report was Terrence Regan of Palm Coast, president of the Florida Urologic Society.  While the group meant well, he said, its data are flawed.

“We think screening for prostate cancer does save lives,” Regan said, if performed on well-informed healthy men who have at least a 10-year life expectancy. 

Florida’s disapproval of the Task Force guidelines is actually official; it came out in November in a reportby the Florida Prostate Cancer Advisory Council, which Vieweg chaired.  The council began work when the federal task force’s interim guidelines were published, showing where things were headed.

The state council concluded that men age 50 and up should be given the option of a PSA test, which shows markers indicating trouble in the prostate gland, every year after being fully informed of the risks and benefits. The screening should begin at 40 for African-Americans and for men who have a family history of the disease, the report said.

Those who choose to undergo the screening and are diagnosed with prostate cancer “should make informed decisions, in consultation with their treating physicians,” on whether it’s appropriate to undergo treatment, the report said.

Vieweg said he was “disappointed” that the federal task force had not listened to critics. He and Regan both view the studies underlying the decision as contaminated, since many men in the control group who weren't supposed to have the screening actually did.

Even though the guidelines are merely a recommendation, not a mandate, they could lead to confusion for many, said both urologists.

“The PSA test has never hurt anyone,” Vieweg said. “What does harm is treating patients who don’t need be treated.“

Regan said that urologists are getting better at resisting the urge to treat all cancers. When treatment is appropriate, he said, it's important that patients be referred to high-volume centers that have the best results.

Further coverage of the national controversy is available from The Associated Pressand the Los Angeles Times.

--Health News Florida is an independent online publication dedicated to journalism in the public interest. Editor Carol Gentry can be reached at 727-410-3266 or by e-mail.



Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.