Some researchers are arguing that current prostate screening procedures are not good enough; they are calling for greater efficiency and thoroughness.
The current relaxed guidelines for prostate cancer screening might be delaying diagnosis as well as treatment for many with aggressive tumors.
Lead researcher Dr. Daniel Barocas, an assistant professor of urologic surgery at Vanderbilt University, commented on the study to the press. He said, “On the positive side, there is a lot of prostate cancer that we don't need to know about. On the negative side, we seem to be missing intermediate and high-risk cancers in men who would be eligible for treatment.” He is calling these missed opportunities to diagnose and treat the disease.
The Journal of Urology will publish the report in its December issue. Guidelines changed when in 2011, the U.S. Preventive Services Task Force recommended against routine prostate specific antigen (PSA) testing, to curb over-diagnosis and overtreatment of prostate cancer. Ever since that time, PSA screening has decreased by 28 percent, according to the researchers.
Experts say some men are at high risk for prostate cancer and should be screened.
Which men are these?
Researchers say these include men with a family history of prostate cancer, and black men who have a predisposition to the disease.
Dr. Barocas also said, “Screening should be combined with treatment. Low-risk cancer need not be treated but watched, while high-risk cancer should be treated.”
Barocas and his team used the U.S. National Cancer Database to look at the effect of the new guidelines on the number of new prostate cancer diagnoses between January 2010 and December 2012.
The expert team found that the number of prostate cancer diagnoses dropped more than 12 percent (1,363 cases) in the month after the draft guideline was issued. That number continued to fall to an overall decline of 28 percent in the year after the draft guideline was put in place.
“The diagnoses of low, intermediate and high-risk prostate cancers all decreased significantly, but diagnoses of prostate cancer that had spread beyond the prostate did not change, they found. The decreases were similar for all ages, races, income and insurance,” according to CBS news.
Researchers also found that in the year after the guidelines were published, diagnoses of new low-risk cancers dropped nearly 38 percent and continued to fall more heavily than diagnoses of more aggressive cancer.
Research further showed that, prostate cancer diagnoses fell by 23 percent to 29 percent among men over 70 and by 26 percent among men who were not likely to live long enough to take advantage of early treatment options.
Dr. Anthony D'Amico, chief of genitourinary radiation oncology at Brigham and Women's Hospital and Dana-Farber Cancer Institute in Boston, commented on the findings.
He said, “These findings are consistent with what we hoped would not happen. It is likely that men will develop more advanced prostate cancer before it is diagnosed and be less likely to be cured, he added. This is a warning that we are not picking up patients who are curable.”
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