Use of controversial prostate cancer test may be holding steady

(Reuters Health) - Doctors at one large U.S. medical center didn’t cut back on their orders of a controversial prostate cancer test even though a government-backed panel advised against its use, according to a new study.

Orders for prostate-specific antigen (PSA) tests didn’t significantly change at UT Southwestern Medical Center in Dallas after 2012, when the U.S. Preventive Services Task Force (USPSTF) recommended against it, warning with “moderate certainty” that the benefits of PSA-based screening for prostate cancer do not outweigh the harms.

“It was important for us to have a good understanding of how we’re using PSA testing and the impact of U.S. Preventive Services Task Force,” said senior author Dr. Yair Lotan, who is chief of urologic oncology at UT Southwestern.

Prostate cancer is the most common malignancy in U.S. men, according to the National Cancer Institute. An estimated 180,890 men in the U.S. will be diagnosed with the cancer in 2016, and 26,120 will die of it.

A PSA test measures the amount of a protein known as prostate-specific antigen in a man’s blood. Elevated levels sometimes signal prostate cancer. Often, however, the test incorrectly suggests there is cancer, according to the group. Those so-called false positives can cause anxiety and lead to unneeded additional tests.

Also, most prostate cancers tend to be slow-growing. Even if PSA testing leads to a diagnosis of prostate cancer, it’s not possible to know if that cancer will ever cause a problem - but worried patients may opt for unneeded treatments such as surgery, radiation or hormone therapy.

Recently, actor Ben Stiller wrote online that a PSA test “literally” saved his life by catching his early prostate cancer. The USPSTF says there is no way to know which cancers will go on to be deadly, though.

To see if the USPSTF recommendation had an effect on test-ordering patterns at their medical center, the researchers analyzed data from 275,784 hospital visits made between 2010 and 2015.

During that time, there were 63,722 orders for PSA tests. Primary care providers ordered 17,315 of those tests and there were 858 referrals to urologists.

Before and after the 2012 USPSTF recommendation, the researchers saw similar numbers of PSA tests ordered per visit, similar numbers of men being advised to see a urologist and similar average age at the time of referral.

The researchers say adoption of external recommendations is slow and incremental.

There are also some conflicting recommendations from other panels and organizations. Both the American Cancer Society and the American Urological Association recommend more nuanced approaches to PSA testing that involve discussions between patients and doctors.

Lotan said men should realize the risks of prostate cancer differ depending on the person. For example, African Americans, men with a family history and people with certain genetic predispositions are at higher risk.

Proceeding with PSA testing is “a personal decision and the important factor here is that men become informed about the significance of it,” he said.

He also cautioned that the new study can’t speak for other medical centers across the country.

“We can only report on the men at our institution and how the Task Force’s recommendation impacted our population,” he said.

SOURCE: Cancer, online September 22, 2016.