U.S. Panel: Healthy Men Don't Need Prostate Screening
Routine screening for prostate cancer does not help save the lives of healthy men and often triggers the need for more tests and treatments, a U.S. government health panel said Friday.
The U.S. Preventive Services Task Force's draft recommendations, which will be open to public comment on Tuesday, are likely to face a pushback from advocates of the PSA blood test, as well as from drugmakers and doctors who benefit from the now-lucrative screening industry.
Based on the results of five clinical trials, the recommendation to avoid a prostate-specific antigen test -- which measures the level of the protein in the blood -- applies to healthy men of all ages without suspicious symptoms.
But it could have an especially dramatic impact on care for men aged 50 and older, who are routinely administered the PSA test.
"The principal risk is overdiagnosis and overtreatment. Most of the cancers that we detect are not cancers that would have ever gone on to cause a man harm in his lifetime," panel co-chair Mike LeFevre told AFP.
"The vast majority of cancers don't need to be treated and yet about 90 percent of men getting a PSA-based diagnosis here in the United States end up getting treated, and the risks of treatment are significant."
The task force also found no evidence that other forms of screening, such as an ultrasound or digital rectal exam or ultrasound, are effective. It did not examine whether testing was beneficial to men who have already been treated for the disease or who show suspicious symptoms.
Ana Fadich of the Men's Health Network called the recommendations "puzzling," and pointed to evidence that prostate cancer deaths have dropped thanks to screening and awareness.
The decision puts high-risk patients such as African American men and those exposed to the Agent Orange defoliant "in great danger" as they may be discouraged from screening, she said.
But LeFevre stressed that the panel was not recommending foregoing prostate cancer detection completely -- and instead suggested that those with symptoms consistent with especially aggressive prostate cancer should get diagnostic testing, which is different than routine screening.
"The most important research that needs to be done is to define characteristics of cancers in order to differentiate the cancers that need to be treated from those that don't need to be treated," he said.
Theresa Morrow, co-founder of Women Against Prostate Cancer, acknowledged that PSA screening was imperfect but said it was the best available tool at this time.
"Early stage prostate cancer doesn't have any symptoms, so there is no other way to detect it," she added. "Most of the times, if symptoms are occurring, you're already at late stage cancer. The chances of then being able to cure it are a lot lower."
One million men who received the PSA test and would otherwise not have been treated got surgery, radiation therapy or a combination of both between 1986 and 2005, according to the task force.
It pointed to evidence suggesting that up to five in 1,000 men will die within a month of prostate cancer surgery and between 10 and 70 in 1,000 men will suffer from serious complications.
"Radiotherapy and surgery result in adverse effects," the task force added, noting that 200 to 300 in 1,000 men treated with such therapies have urinary incontinence or impotence.
An estimated 217,730 men in the United States were diagnosed with prostate cancer and 32,050 died last year from the disease, the second most common form of cancer in men after skin cancer.
Source: Agence France Presse
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