Tuesday, August 5, 2008

Prostate Cancer Screening

As mentioned in the New York Times, the U.S. Preventive Services Task Force recently updated its prostate cancer screening guidelines, reaffirming that evidence is lacking to recommend for or against it, and took an additional new step stating that physicians should not routinely screen for prostate cancer in men over 75. This is in contrast to recommendations by other organizations such as the American Cancer Society that recommends doctors offer a PSA blood test and DRE (digital rectal exam) yearly, beginning at age 50 to men who can be expected to live at least 10 more years, and for men at high risk (African American, family history of prostate cancer) screening should begin at age 45.

Why the difference and what should you do?
On the one hand, in 2007, prostate cancer was the leading cause of new cancers for men and second only to lung cancer for cancer death in men. Organizations like the American Cancer Society who are determined to get rid of all cancer encourage screening. On the other hand, it is not clear that finding and then treating prostate cancer will save one's live. This is likely due to the fact that many prostate cancers are slow growing, and men will often die of something else before the prostate cancer spreads. In addition, treatment for prostate cancer is not without risks and complications, such as problems with urination and sexual function.

There is not right answer here, and it is important that you discuss all screening with your doctor. One key thing to determine is that screening and finding cancer doesn't necessarily mean more testing and treating. For example, you might have a PSA test done that is greater than normal, and determine that before proceeding to further testing (biopsy) you might watch and wait. For this reason, I still recommend screening, but advise caution when addressing a positive test. Based on your individual risks, values, etc. you and your physician can determine how best to proceed.

1 comment:

Anonymous said...

This week we heard that screening for prostate cancer may do more harm than good—particularly for older men. I understand that, I suppose. Prostate cancer tends to grow slowly, and the significance of test results is not entirely clear.

I worry that in a twist of logic we will generalize a very specific recommendation. I worry that the message will shift from “Men over 75 should not be screened for prostate cancer” to “No-one should be screened for prostate cancer” to (and this is the scariest part) “I shouldn’t be screened for any cancer.”

Every day in the United States more than 100 people die of colorectal cancer because they weren’t screened when they should have been. Every day.

Colorectal cancer is the second leading cause of cancer death in this country, yet a simple screening will reduce the risk of having this disease by 80% or more.

The debate about prostate cancer screening will go on for a long time. One thing is not debatable though—cancer screening in general, and screening for colon cancer in particular, saves lives.