U.S. Panel Questions Prostate Screening

[Guest guest]

'Dramatic' Risks For Older Men Cited

By Rob Stein

Washington Post Staff Writer

Tuesday, August 5, 2008; Page A01

The blood test that millions of men undergo each year to check for prostate

cancer leads to so much unnecessary anxiety, surgery and complications that

doctors should stop testing elderly men, and it remains unclear whether the

screening is worthwhile for younger men, a federal task force concluded

yesterday.

In the first update of its recommendations for prostate cancer screening in

five years, the panel that sets government policy on preventive medicine

said that the evidence that the test reduces the cancer's death toll is too

uncertain to endorse routine use for men at any age, and that the potential

harm clearly outweighs any benefits for men age 75 and older.

" The benefit of screening at this time is uncertain, and if there is a

benefit, it's likely to be small, " said Ned Calonge, who chairs the

16-member U.S. Preventive Services Task Force. It published the new

guidelines today in the ls of Internal Medicine. " And on the other side,

the risks are large and dramatic. "

The task force and other groups concluded previously that it was unclear

whether the benefits of the prostate-specific antigen, or PSA, test outweigh

the risks. The new review of the scientific literature found no evidence to

alter that assessment for younger men. It did find enough new data to

recommend for the first time against screening for older men.

" We felt with sufficient certainty that your risk of being harmed exceeded

your potential benefits starting at age 75, " Calonge said.

The recommendations come at a time when doctors are increasingly questioning

whether many tests, drugs and procedures are being overused, unnecessarily

driving up health-care costs and exposing patients to the risks of unneeded

treatment.

" There is this idea that more is always better, and if a test is available

we should use it, " said A. Brody, a professor of family medicine at

the University of Texas Medical Branch at Galveston. " A lot of times, we're

doing more harm than good. "

The guidelines address perhaps the most important and contentious issue in

men's health, and were praised by officials at several leading medical

groups, including the National Cancer Institute and the American Cancer

Society. But they drew strong criticism from others who are convinced that

routine screening is necessary.

" I think they're really missing the boat, " said J. Catalona, a

professor of urology at Northwestern University. " It's a disservice to

patients. A lot of men die from prostate cancer, and there's just an

overwhelming amount of evidence that screening saves lives. "

Each year, prostate cancer is diagnosed in more than 218,000 U.S. men. About

28,000 die of it, making it the most common cancer and second-leading cancer

killer among men.

The PSA test, which measures a protein in the blood produced by prostate

tissue, has significantly increased the number of prostate cancer cases

being diagnosed at very early stages. But it remains unclear whether that

translates into a reduction in the death rate from the disease. Prostate

cancer often grows so slowly that many men die from something else without

ever knowing they had it.

Because it is not clear precisely what PSA level signals the presence of

cancer, many men experience stressful false alarms that lead to unnecessary

surgical biopsies to make a definitive diagnosis, which can be painful and

in rare cases can cause serious complications.

Even when the test picks up a real cancer, doctors are uncertain what, if

anything, men should do about it. Many men simply are monitored closely to

see if the tumor shows signs of growing or spreading. Others undergo

surgery, radiation and hormone treatments, which often leave them

incontinent, impotent and experiencing other complications.

" People say, 'What's the harm in screening?' In fact, there are several ways

in which screening can actually be harmful, " said L. Parnes of the

National Cancer Institute.

Since the task force issued its previous recommendations in 2002, at least

eight new studies have been published. Among them was a large Swedish review

that found that men age 65 and older who were treated for prostate cancer

were no more likely to survive than those who were not.

" If therapy isn't providing meaningful benefit, then how could screening

provide benefit? " Calonge said. " And we know that the therapy produces

significant harms. "

Men younger than 75 should be carefully counseled about the potential risks

associated with the test and the lack of evidence about any benefit before

getting it, the panel said.

Men at high risk for prostate cancer, such as African Americans and those

with a family history of the disease, are the most likely to benefit from

PSA screening. But the panel concluded that the evidence remains

inconclusive for those men as well.

Several other experts said that the new recommendations strike a careful

balance, and that they hope they might discourage large-scale screenings

where the risks and benefits are not carefully laid out.

" I think they are right on target, " Parnes said.

Others were highly critical, noting that prostate cancer death rates have

plummeted in many countries after they instituted widespread PSA screening.

" We have seen a dramatic drop in mortality, " said J. Brantley Thrasher,

chairman of the urology department at the University of Kansas and a

spokesman for the American Urological Association. " They're not paying

attention to that. "

Others objected to setting an age cutoff, saying men should be evaluated

individually.

" Men are living a lot longer and healthier these days. I play golf with

84-year-old guys who beat me all the time, " said E. Crawford, a

professor of surgery and radiation at the University of Colorado at Denver.

" You have to individualize treatment. If a 75-year-old man is found to have

high-grade prostate cancer, it's going to kill him, and we can intervene and

do something for him. "

Two large studies are underway -- one in the United States and one in Europe

-- to answer the question of whether screening reduces mortality.

" If it turns out that PSA screening and aggressive treatment saves lives,

maybe all the harm that it has caused is worth it, " said Otis W. Brawley,

chief medical officer at the American Cancer Society. " If PSA screening does

not save lives, then it's clearly not worth it. We just don't know yet. "

[Guest guest]

This writer gets the award for the number of times

saying the same thing without actually saying what

the risk is. Of death that is.

Lotsa things can be fixed if you're still alive.

This is just an economic thing. They should try

selling cutting out breast cancer screening to their

mothers, wives, mothers-in-law.

So many illogics here - not worth sorting them out.

Regards

------- Original Message -------

From : Francesca Skelton[mailto:fskelton@...]

Sent : 8/5/2008 7:28:09 AM

To :

Cc :

Subject : RE: [ ] U.S. Panel Questions

Prostate Screening

'Dramatic' Risks For Older Men Cited

By Rob Stein

Washington Post Staff Writer

Tuesday, August 5, 2008; Page A01

The blood test that millions of men undergo each year

to check for prostate

cancer leads to so much unnecessary anxiety, surgery

and complications that

doctors should stop testing elderly men, and it

remains unclear whether the

screening is worthwhile for younger men, a federal

task force concluded

yesterday.

In the first update of its recommendations for

prostate cancer screening in

five years, the panel that sets government policy on

preventive medicine

said that the evidence that the test reduces the

cancer's death toll is too

uncertain to endorse routine use for men at any age,

and that the potential

harm clearly outweighs any benefits for men age 75

and older.

" The benefit of screening at this time is uncertain,

and if there is a

benefit, it's likely to be small, " said Ned Calonge,

who chairs the

16-member U.S. Preventive Services Task Force. It

published the new

guidelines today in the ls of Internal Medicine.

" And on the other side,

the risks are large and dramatic. "

The task force and other groups concluded previously

that it was unclear

whether the benefits of the prostate-specific

antigen, or PSA, test outweigh

the risks. The new review of the scientific

literature found no evidence to

alter that assessment for younger men. It did find

enough new data to

recommend for the first time against screening for

older men.

" We felt with sufficient certainty that your risk of

being harmed exceeded

your potential benefits starting at age 75, " Calonge

said.

The recommendations come at a time when doctors are

increasingly questioning

whether many tests, drugs and procedures are being

overused, unnecessarily

driving up health-care costs and exposing patients to

the risks of unneeded

treatment.

" There is this idea that more is always better, and

if a test is available

we should use it, " said A. Brody, a professor

of family medicine at

the University of Texas Medical Branch at Galveston.

" A lot of times, we're

doing more harm than good. "

The guidelines address perhaps the most important and

contentious issue in

men's health, and were praised by officials at

several leading medical

groups, including the National Cancer Institute and

the American Cancer

Society. But they drew strong criticism from others

who are convinced that

routine screening is necessary.

" I think they're really missing the boat, " said

J. Catalona, a

professor of urology at Northwestern University.

" It's a disservice to

patients. A lot of men die from prostate cancer, and

there's just an

overwhelming amount of evidence that screening saves

lives. "

Each year, prostate cancer is diagnosed in more than

218,000 U.S. men. About

28,000 die of it, making it the most common cancer

and second-leading cancer

killer among men.

The PSA test, which measures a protein in the blood

produced by prostate

tissue, has significantly increased the number of

prostate cancer cases

being diagnosed at very early stages. But it remains

unclear whether that

translates into a reduction in the death rate from

the disease. Prostate

cancer often grows so slowly that many men die from

something else without

ever knowing they had it.

Because it is not clear precisely what PSA level

signals the presence of

cancer, many men experience stressful false alarms

that lead to unnecessary

surgical biopsies to make a definitive diagnosis,

which can be painful and

in rare cases can cause serious complications.

Even when the test picks up a real cancer, doctors

are uncertain what, if

anything, men should do about it. Many men simply are

monitored closely to

see if the tumor shows signs of growing or spreading.

Others undergo

surgery, radiation and hormone treatments, which

often leave them

incontinent, impotent and experiencing other

complications.

" People say, 'What's the harm in screening?' In fact,

there are several ways

in which screening can actually be harmful, " said

L. Parnes of the

National Cancer Institute.

Since the task force issued its previous

recommendations in 2002, at least

eight new studies have been published. Among them was

a large Swedish review

that found that men age 65 and older who were treated

for prostate cancer

were no more likely to survive than those who were not.

" If therapy isn't providing meaningful benefit, then

how could screening

provide benefit? " Calonge said. " And we know that the

therapy produces

significant harms. "

Men younger than 75 should be carefully counseled

about the potential risks

associated with the test and the lack of evidence

about any benefit before

getting it, the panel said.

Men at high risk for prostate cancer, such as African

Americans and those

with a family history of the disease, are the most

likely to benefit from

PSA screening. But the panel concluded that the

evidence remains

inconclusive for those men as well.

Several other experts said that the new

recommendations strike a careful

balance, and that they hope they might discourage

large-scale screenings

where the risks and benefits are not carefully laid out.

" I think they are right on target, " Parnes said.

Others were highly critical, noting that prostate

cancer death rates have

plummeted in many countries after they instituted

widespread PSA screening.

" We have seen a dramatic drop in mortality, " said J.

Brantley Thrasher,

chairman of the urology department at the University

of Kansas and a

spokesman for the American Urological Association.

" They're not paying

attention to that. "

Others objected to setting an age cutoff, saying men

should be evaluated

individually.

" Men are living a lot longer and healthier these

days. I play golf with

84-year-old guys who beat me all the time, " said E.

Crawford, a

professor of surgery and radiation at the University

of Colorado at Denver.

" You have to individualize treatment. If a

75-year-old man is found to have

high-grade prostate cancer, it's going to kill him,

and we can intervene and

do something for him. "

Two large studies are underway -- one in the United

States and one in Europe

-- to answer the question of whether screening

reduces mortality.

" If it turns out that PSA screening and aggressive

treatment saves lives,

maybe all the harm that it has caused is worth it, "

said Otis W. Brawley,

chief medical officer at the American Cancer Society.

" If PSA screening does

not save lives, then it's clearly not worth it. We

just don't know yet. "