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If there was a test to help you determine your risk of prostate cancer, wouldn't you want it? Isn't a screening test useful? Some doctors argue that it's not. Learn why...


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8/8/2014
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Many people wonder whether they need to be screened for prostate cancer. Some doctors say this screening is mandatory. Others say it is not. What is the best guideline to go by?

The New York Times reports on a study that says prostate cancer screening is unnecessary.

A European study showed that blood test screening for prostate cancer was effective. But many experts still say that the screening is superfluous. 

Why do they find that over treatment and too much screening is disadvantageous? Experts against screening say that the cons do not outweigh the pros. Unnecessary biopsies and treatments can render men incontinent and impotent.

The new study The Times says was recently published in the Lancet.

What did it find?

The new research shows, “That midlife screening with the prostate-specific antigen, or PSA, screening test lowers a man’s risk of dying of the disease by 21 percent. The relative benefit sounds sizable, but it is not particularly meaningful to the average middle-age man, whose risk of dying of prostate cancer without screening is about 3 percent. Based on the benefit shown in the study, routine PSA testing would lower his lifetime cancer risk to about 2.4 percent,” according to The Times.

The screening helped around one out of 780 men but the study’s authors say that the screening is still not more beneficial than detrimental. They say instead doctors should only focus on men who have an increased risk of getting prostate cancer. They also say that physicians should get better at identifying nonaggressive cancers as well, so that men do not have to undergo unnecessary biopsies.

The study’s lead author, Dr. Schroder, a urologist, issued a statement saying, “We know we are finding a substantial number of cancers, in the range of 30 to 50 percent, that would never do any harm and would not lead to death. This over diagnosis is unacceptable because it also leads to treatment. That’s why there is consensus worldwide, with very few exceptions, that the time has not come to recommend population-based screening.”

The study’s results were based on thirteen years of research from a continuing randomized study of around 165,000 men. The findings are probably going to create confusion about the general advantages and risks of the PSA test, which utilizes a blood sample to identify men at a higher risk for prostate cancer. The test often puts men on a line of repeated biopsies and testing, and for some, treatment of a cancer that would have never been a problem if it had not been touched.

Statistics show, “In 2011, the United States Preventive Services Task Force concluded that healthy men should not be screened for prostate cancer, a finding that drastically changed the standard of care for middle-age American men who had grown accustomed to annual screenings.”

How did this recommendation come about?

The task force came to their recommendation against PSA testing by looking at around 10 years of research from two large studies: the United States-based Prostate, Lung, Colorectal and Ovarian (P.L.C.O.) cancer screening trial of around eighty thousand men, and earlier results from the current study, the European Randomized study of Screening for Prostate Cancer. Supplemental information collected from the European trial since then has shown a miniscule bigger advantage over time as a consequence of screening, along with a still sizable risk of over treatment and over diagnosis.

Dr. Thompson, an expert on cancer therapy, from the University of Texas told The Times the decision whether to regularly prescribe prostate cancer screening has always been a complicated story. He further said that better ways such as biopsies, guided by magnetic resonance imaging tests (MRI), “along with personalized risk assessment and more informed decision making by men and their doctors were a better way to use the PSA test than to screen every man of a certain age. The majority of men who get PSA screening will not benefit from it. If you do PSA testing in a more sophisticated, contemporary way, there may be the possibility of achieving the mortality reduction while reducing the morbidity impact.”

The American study and the European study have their own flaws as well. The American study included some men who had already gotten a PSA test before so a new PSA test was not likely to find anything. The European study included men from various countries yet some men from certain countries received a benefit and men from other countries did not at all. And there was no reasoning for this disparity.

The lead author of the American study, Dr. Andriole, told the Times, “I think this additional follow-up doesn’t change much. I think there is a benefit to PSA testing, but unfortunately, we’ve been overdoing it, screening the wrong men, over treating way too many men, and the benefit of screening is being outweighed by the side effects of overtreatment.”

Experts say that men who are confused about whether to get a PSA test do have other options. There are new M.R.I. tests that can lead targeted prostate biopsies. These can aid in finding dangerous cancers that need treatment. Therefore men who do not need to be treated can then be ruled out. Dr. Thompson stressed the importance of doctors fully informing patients so that they can make their own decision about whether they need a PSA test. He further stated that men whose father or grandfather had prostate cancer would be more inclined to get the test and should get it as they will have a genetic predisposition for the cancer. 



Category: Misdiagnosis and Failure to Diagnose


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