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Panel advises against prostate cancer screening

Friday, October 7, 2011 | 10:58 a.m. CDT; updated 11:20 a.m. CDT, Friday, October 7, 2011

WASHINGTON — No major medical group recommends routine prostate specific antigen blood tests to check men for prostate cancer, and now a government panel is saying they do more harm than good. According to the panel, healthy men should no longer receive the tests as part of routine cancer screening.

The panel's guidelines had long advised men over 75 to forgo the tests. The new recommendation extends that do-not-screen advice to healthy men of all ages.

The recommendation by the U.S. Preventive Services Task Force, being made public on Friday, will not come as a surprise to cancer specialists.

Yet, most men over 50 have had at least one PSA blood test, the assumption being that finding cancer early is always a good thing.

Not so, said Virginia Moyer of the Baylor College of Medicine, who heads the task force.

"We have put a huge amount of time, effort and energy into PSA screening, and that time, effort and energy, that passion, should be going into finding a better test instead of using a test that doesn't work," Moyer said.

Too much PSA in the blood only sometimes signals prostate cancer is brewing. It also can mean a benign enlarged prostate or an infection. Worse, screening often detects small tumors that will prove too slow-growing to be deadly. And there's no sure way to tell in advance who needs aggressive therapy.

The task force analyzed all the previous research on this subject, including five major studies, to evaluate whether routine screening reduces deaths from prostate cancer. The conclusion: There's little if any mortality benefit.

But there is harm from routine screening: impotence, incontinence, infections, even death that can come from the biopsies, surgery and radiation, Moyer said.

One study estimated 2 of every 5 men whose prostate cancer was caught through a PSA test had tumors too slow-growing to ever be a threat.

Yet, Moyer said, 30 percent of men who are treated for PSA-discovered prostate cancer suffer significant side effects, sometimes death, from the resulting treatment.

About a third of men ages 40 to 60 have brewing prostate cancer but "the huge majority of them will never know it in their lifetime if they are not screened," she added.

The task force previously had considered the evidence for or against PSA screening inconclusive. The new recommendation said not to routinely screen. That recommendation is a draft that is open for public comment beginning next week.

"We have been long concerned, and it has been apparent for some years, that some supporters of prostate cancer screening have overstated, exaggerated and in some cases misled men about the evidence supporting its effectiveness," Otis Brawley of the American Cancer Society said in a statement. "We need balanced, truthful information to be made widely available to physicians and patients when making important health decisions."

The society had not seen the new recommendation yet, but has long advised men to consider the pros and cons of PSA screening before deciding on their own.

Moyer said the recommendation only means that doctors shouldn't bring up the option for healthy men. If a man asks for a PSA test and wants it after being informed of the evidence, he should receive it, she said. Likewise, it's appropriate to use PSA tests to examine a man with possible prostate symptoms. 


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