Doctors Advise Against Routine Prostate Screening

An influential medical organization advised against routine screening of men for prostate cancer, saying it was not yet clear whether the benefits outweighed the risks.
The American College of Physicians, in the March 15 issue of its journal Annals of Internal Medicine, said the decision on whether to undergo prostate screening should be an individual one made by a patient and his doctor.

Key to making the decision are a patient’s views of whether the possible — but still unproven — benefits of early prostate cancer detection and treatment outweigh risks and side effects that include false test results, impotence and incontinence, or even death following surgery.

“Screening for prostate cancer is not for everyone,” said Dr. Harold Sox, incoming president of the medical group, which represents 100,000 experts in adult medicine. “It is a complex decision that patients should make after talking to their physician, understanding the risks and benefits, and coming to an informed, individualized decision.”

The recommendations run counter to advice from the American Cancer Society and groups representing medical specialists in urology and radiology, all of which recommend some form of annual screening beginning at age 40.

The conflicting positions echo a contentious debate over the benefits of routine breast cancer screening through mammograms for women between 40 and 50.

Prostate cancer is the most commonly diagnosed cancer among American men, and it kills about 40,000 annually. However, the cancer can be very slow-growing, meaning many men who develop the disease would die of something else first.

In a review of prostate cancer research published in the current Annals, Dr. Christopher Coley of Harvard University and his co-authors said there may well be benefits to early detection of prostate cancer but this has not been proven.

“The available observational data do not warrant the conclusion that early detection of prostate cancer using the tests now available unequivocally does more good than harm,” the researchers said.

Common tests used in prostate cancer screening include digital rectal examinations and blood tests.

A statistical model conducted by researchers, using a combination of favorable assumptions about treatment outcomes, said there may be a benefit to screening, especially for men in their 50s and 60s.

Even for men in their 50s, it said, the maximum benefit of early detection and treatment would be, when averaged among all patients in the group, no more than a few extra weeks of life per person. But for those diagnosed with cancer surgical treatment offers an average additional life expectancy of about 3 years for men aged 55, and 1.5 years for 65-year-olds.

“Men who place the highest premium on the possibility of avoiding advanced prostate cancer should probably choose screening. However, men who are averse to treatment-related risks or those who prefer to pursue only therapy that has a proven benefit should probably reject screening,” it said.

Writing in the same issue of the journal, Dr. David Middleton of the University of Utah medical school’s urology department said he supported a program of annual digital rectal examinations for patients over 50. This should be coupled, he said, with an initial “baseline” blood test to determine levels of prostate-specific antigen, a substance produced by the gland, which can indicate cancer.

The American College of Physicians said black men and men with a family history of prostate cancer faced a higher risk of the disease, but it did not recommend a different set of care guidelines for these men.

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