In a move that could lead to significant changes in medical care
for older men, a national task force in the United States has
recommended that doctors stop screening men aged 75 and older for
prostate cancer because the search for the disease in that group is
causing more harm than good.
The guidelines, issued Monday by the U.S. Preventive Services
Task Force, represent an abrupt policy change by an influential
panel that had withheld any advice regarding screening for prostate
cancer, citing a lack of reliable evidence. Although the task force
still has not taken a stand on the value of screening in younger
men, the shift is certain to re-ignite the debate about the
appropriateness of prostate cancer screening at any age.
Screening for prostate cancer is typically performed with a blood
test measuring prostate-specific antigen, or PSA, levels. Widespread
PSA testing has led to high rates of prostate cancer detection. Last
year, more than 218,000 men in the United States were found to have
the disease.
Yet various studies suggest the disease is "overdiagnosed" - that
is, detected at a point when the disease probably would not affect
life expectancy - in 29 percent to 44 percent of cases. Prostate
cancer often progresses very slowly, and a large number of the
cancers discovered through screening probably will never cause
symptoms during the patient's lifetime, particularly if that patient
is older.
At the same time, aggressive treatment of prostate cancer can
greatly reduce a patient's quality of life, resulting in
complications like impotence and incontinence.
Past task force guidelines noted that there was no benefit to
prostate cancer screening in men with less than 10 years left to
live. Since it can be difficult to assess life expectancy, it was an
informal recommendation that had limited impact on screening
practices. But the new guidelines take a more definitive stand,
stating that the age of 75 is clearly the point at which screening
is no longer appropriate.
The task force was created by Congress to analyze current medical
research and to make recommendations about preventive care for
healthy people. Its guidelines are viewed as highly credible and
often are relied on by practicing physicians in making decisions
about patient care.
It is estimated that one out of every three U.S. men age 75 and
older is now screened for prostate cancer.
"When you look at screening, you have a chance the screening will
help you live longer or better, and you have the chance that
screening detection and treatment will harm you," said Ned Calonge,
chairman of the task force and chief medical officer for the
Colorado Department of Public Health and Environment. "At age 75,
the chances are great that you'll have negative impacts from the
screening."
It is estimated that one of every three men aged 75 and older is
now screened for prostate cancer, though some studies suggest the
number is higher.
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