Unnecessary PSA Testing: A Microcosm of the Waste in the Health Care System
The Journal of the National Cancer Institute recently announced that regular Prostate-Specific Antigen (PSA) testing doesn’t save lives. This conclusion matches that of the US Preventive Services Task Force, the American Cancer Society and the American Urologic Association. Each organization advises against PSA testing in older men.
Statistics show that PSA testing leads to over-diagnosis and over-treatment of prostate cancer. The over-use of PSA testing, despite federal recommendations, is indicative of the larger problem of wasteful care driving up costs in the medical system. The prevalence of PSA testing should be curtailed in order to avoid unnecessarily diagnosing and treating men for prostate cancer in order to curb wasteful health expenditures.
If higher incidence rates of prostate cancer were indicative of lives saved by detecting harmful cancers sooner, allowing for earlier life-saving treatment the overall death rate should decrease. However, the death rate declined only slightly; which can also be attributed to better treatment options and the incidence rate rapidly rising.
In experiments done with a control group (no PSA testing) and a group with regular PSA testing, more cancers were diagnosed in the experimental group; but the same group did not yield an improved death rate. The conclusion did not change when researchers looked at the data based on older or younger men and those that did or did not have other medical conditions.
PSA testing lacks legitimacy as a screening test for cancer because PSA scores naturally rise with age. Therefore, many men who receive a prostate cancer diagnosis have a smaller number of abnormal cells and are more likely to die from another cause than from cancer. However, most of these men are treated with chemotherapy and radiation which can potentially cause more harm than their prostate. Researchers estimate that, as a result of PSA testing, over one million men have received unnecessary and harmful treatment for a disease that would not have affected their life expectancy.
Aside from the unintended harm due to over-treatment, PSA testing also creates waste in the medical system and contributes to growing health care costs. The South and Midwest had higher rates of testing men over 80. Which explains, in part, the higher health care costs in these regions due to the tendency to over-diagnose and over-treat patients. PSA testing exemplifies the contribution of defensive medicine to rising health care costs.
In general, PSA testing is representative of the larger issue of wasteful care because it continues to be done regularly despite the lack of sufficient evidence of health benefits. Additionally, many doctors feel pressured to screen for cancers in order to avoid malpractice suits. If a patient who did not receive a PSA test developed prostate cancer, his doctor may be liable in a lawsuit in the future.
PSA testing may still be beneficial for certain groups, such as African-American men and people with a family history of prostate cancer, but it seems detrimental to the average man. Ideally, the test would have the ability to distinguish between types of cancer such as fast/slow growing and likely to affect life expectancy. This would help avoid potentially harmful treatment. Men should be fully informed of the realities of PSA testing before they consent to the test and decide for themselves whether or not the test is worth the risk of over-diagnosis.
Photo Credit: Wikimedia Commons