New Screening Guidelines: Don't Test Men Over 75 For Prostate Cancer

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Main Category: Prostate / Prostate Cancer
Also Included In: Men's health;  Medical Devices / Diagnostics
Article Date: 13 Aug 2008 - 0:00 PDT

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Over the age of 75 years, men should no longer be screened for prostate cancer, according to recommendations from the U.S. Preventive Services Task Force published on August 5, 2008 in the Annals of Internal Medicine. Additionally, they indicate that younger men should discuss the potential risks and benefits of the prostate-specific antigen (PSA) treatment with their doctors before performing the test.

Prostate cancer affects this small gland in the male reproductive system. In 2007, approximately 218,890 men were diagnosed with prostate cancer in the U.S.. One in six men will receive this diagnosis at some point in his lifetime. Currently, screening is performed using a digital rectal exam or the PSA test. While the PSA test has a higher sensitivity and is more likely to detect cancer, these cancers are usually in very early stages and thus take years to affect the man's health. Often, cancers detected with this tests take more than 10 years to take hold.

The screening process, while relatively standard, can be associated with some physical and psychological harms. Physically, the man must undergo biopsies, and there is the chance for unnecessary treatment. Psychologically, false positives may be detected, leading to anxiety. The treatment of prostate cancer itself can have complications including urinary incontinence and impotence.  However, early stage untreated cancers rarely cause any of these side effects -- meaning that, at a certain age, it is possible that man is harmed by being screened for prostate cancer with few potential benefits.

Men older than 75 in the U.S. have an average expectancy of approximately 10 years, and in this population, death is more likely to occur due to heart disease or stroke, rendering knowledge about prostate cancer status largely moot. Thanks to this, screening for prostate cancer, according to the Task Force, provided relatively few health benefits while still leading to harm which was mostly physical but partially psychological when men are 75 and older.

Men younger than 75 can also have a life expectancy shorter than the next ten years as a result of chronic diseases. Individuals in this population are also unlikely to benefit from screening.
For younger men, they concluded that there is not sufficient evidence to balance the risks and harms, so each individual should assess his risks separately.

The Task Force Chair, Ned Calonge, M.D., M.P.H., summarizes: "Because many prostate cancers grow slowly, early detection may not benefit a patient's health and in some cases may even cause harm." He continues, explaining current policies on the screening process: "We encourage men younger than 75 to discuss with their clinicians the potential--but uncertain--benefits and the possible harms of getting the PSA test before they decide to be screened."

Nearly one-third of all men in the U.S. over the age of 75 are having PSA testing performed, according to current data. Most medical organizations suggest that it is prudent to discontinue screening when an individual has an average expectancy of less than 10 years, but this is the first explicit age to be specified for this test. There are presently two ongoing studies that will help elucidate the potential benefits of screening in men under 75: the National Cancer Institute's (NCI) Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial and the European Study of Screening for Prostate Cancer.

This Task force is an independent panel of experts in prevention and primary care, with a mission to conduct rigorous, impartial analyses of the evidence for and against many clinical preventive services such as screening, counseling, and preventive medications. for clinical preventive services, the Task Force defines many of the gold standard methods.

For clinicians, additional information can be found on the Agency for Health Care Research and Quality website  or AHRQ's National Guideline Clearinghouse.

For men who have been diagnosed with prostate cancer, information about treatment can be found on the effective health care portion of the AHRQ website, describing effective health care.

Screening for Prostate Cancer: U.S. Preventive Services Task Force Recommendation Statement
U.S. Preventive Services Task Force
Annals Internal Medicine, 5 August 2008, Volume 149, Issue 3, Pages 185-191
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Written by Anna Sophia McKenney
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