Early Prostate Screenings May Not Be Worth It

Prostate cancer screenings may be most beneficial starting at age 50

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Prostate cancer is the most common non-skin cancer in men. While some specialty organizations recommend that screening begin at age 40, there is little evidence showing real benefits to screening at this age.

Scientists who have analyzed studies on this topic recently concluded that there is not enough evidence to justify getting a prostate screening at age 40 for the average risk male.

Specifically, men in this age range need to know the risks and benefits of prostate specific antigen (PSA) screening for prostate cancer. The PSA is a protein enzyme that is released into the blood from the prostate gland.

A high level of PSA in the blood has been linked to an increased chance of having prostate cancer.

"Get a prostate cancer screening - speak with a doctor."

Richard Hoffman, MD, professor of medicine at the University of New Mexico School of Medicine and staff physician at the New Mexico VA Health Care System in Albuquerque, served as lead author of a paper evaluating approaches to prostate cancer screening.

The American Cancer Society suggests that men at average risk for prostate cancer should have a discussion with a doctor about screening starting at age 50. Two medical specialty groups both urge men who are 40 and older to consider a prostate screening.

The American Urological Association guideline panel and the National Comprehensive Cancer Network recommend that average risk men first be counseled about prostate cancer screening for prostate cancer at age 40.

The authors point out that the American Cancer Society advocates in its most recent screening guidelines for holding screening discussions before 50 years only with men in high-risk populations. These populations may include African Americans and men who have had a family history of prostate cancer.

Investigators highlight that of 29,093 US prostate cancer deaths in 2007, nearly 96 percent occurred among men aged 60 years and older; only about 100 deaths (and just under 3 percent of incident cases) occurred in men aged 50 years and younger.

Researchers also refer to data from the European Randomized Study of Screening for Prostate Cancer (ERSPC) suggesting that the lifetime benefit of beginning routine screening for average risk men at age 40 rather than age 50 years would be less than 1 fewer prostate cancer deaths per 1,000 men.

While the costs of a PSA test is about $50, according to Dr. Hoffman, he and his colleagues voice concern that testing average risk men younger than 50 is a distraction for primary care physicians.

“Primary care providers have a limited amount of time to spend with patients during office visits, so the providers need to focus on offering preventive services that have been proven effective,” said Dr. Hoffmann.

He told dailyRx News, “Our major concern is that we have no evidence that looking for cancers among men in their 40s will lead to better outcomes,” he said.

“However, we do know that screening younger men will lead to many false positive tests—requiring biopsies—and may lead to diagnosing cancers that will never cause problems or that could be effectively treated years later," Dr. Hoffman said.

“In that case, screening doesn't reduce the chance of dying from prostate cancer, it just gives a man that many more years of living with the psychological burden of having a cancer—and potentially many more years of living with treatment complications.”

The paper was published in the November/December issue of Annals of Family Medicine.

Dr. Hoffman reports receiving payment for providing expert testimony regarding prostate cancer screening, National Institutes of Health grant funding to evaluate prostate cancer screening in the elderly, and partial salary support for medical editing from Informed Medical Decisions Foundation.

Reviewed by: 
Review Date: 
November 16, 2012
Last Updated:
May 3, 2013