Does Screening Tests Save Life? Ben Stiller Creates Prostate News

Earlier this month, actor Ben Stiller announced that he was free of prostate cancer thanks to a routine PSA test he got. His essay encouraged all men to get PSA tests. However, the U.S. Preventive Services Task Force (USPSTF), a voluntary non-profit that makes recommendation for screening tests, does not recommend PSA tests due to very high false positive of such tests (almost 80% false positive) leading to unnecessary biopsies and risk of surgery. About 181,000 new cases of prostate cancer are detected each year and about 26,000 men die each year from this cancer. Almost 3 million men suffer from prostate cancer in the US alone. For such a wide-spread cancer, it seems logical that PSA tests should be routinely conducted just like mammograms are done to detect breast cancer in women. Ben Stiller’s essay created a robust discussion in the medical community on both sides of the debate. Doctors, insurance companies and Medicare rely on USPSTF recommendations for most diagnostic tests, Mr. Stiller argument that his life was saved by a timely PSA tests was met by skepticism. This is not the first time celebrity endorsement of diagnostic screening test has been challenged. A few years back it was actress Angelina Jolie who go double mastectomy and surgical removal of her ovaries due to diagnostic tests indicative of such breast and ovarian cancers and family history. Coming back to the original question, does screening save life? The short answer is that no one knows for certain. From a regulatory point of view, FDA has always been supportive of timely diagnosis and preventive measures to reduce the risk. With increased emphasis of precision medicine, which is highly reliant on early diagnosis, and genetic diagnosis by FDA and EMA, developers of diagnostic tests should find supportive regulators but without USPSTF’s recommendation, insurance coverage of such tests is going to be an issue.