If Prostate Screening Doesn't Work, What Does?

Prostate cancer screenings by age do not lower mortality rates

(RxWiki News) As with a number of other health recommendations, guidelines regarding prostate cancer screenings have been all over the place lately. What's a guy to think? More importantly, what's he to do?

According to a just published long-term study, annual prostate cancer screenings for men in the 50s and 60s do not reduce mortality rates.  Additionally, men who have 7-10 years of life left shouldn't even bother with the tests.

Annual screenings were defined as prostate-specific antigen (PSA) testing and digital rectal examination (DRE).

"If prostate cancer runs in your family or you are African American, get screened."

Washington University School of Medicine in St. Louis followed more than 76,000 men in the Prostate, Lung, Cancer, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Updated results from the study find that after six years of annual screenings, more prostate tumors were diagnosed, but this didn't result in fewer men dying from the cancer.

"The data confirm that for most men, it is not necessary to be screened annually for prostate cancer," says the study's lead author and principal investigator, Gerald Andriole, M.D., chief urologic surgeon at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine.

"A large majority of the cancers we found are slow-growing tumors that are unlikely to be deadly," he pointed out.

The study looked at men between the ages of 55 and 74. They were randomly selected to receive either PSA (prostate-specific antigen) for six years and digital rectal exams for four years, or "routine care," during which they were screened only if their physician recommended it.

Here's what the researchers found:

  • 12 percent more prostate tumors were diagnosed among men who had annual screenings, compared to those who received routine care.
  • The numbers of men who died from prostate cancer did not differ significantly between the groups.
  • In the screened group, 158 men died of prostate cancer, while the disease caused 145 deaths in the routine care group.
  • Men who had serious underlying conditions such as heart, liver or lung disease were more likely to die of these or other causes than from prostate cancer.
  • Annual screenings didn't reduce prostate cancer deaths among men in their 50s and 60s, as researchers had hoped

Dr. Andriole says that "only the youngest men — those with the longest life expectancy — are likely to benefit from screening.

We need to modify our current practices and stop screening elderly men and those with a limited life expectancy," said Dr. Andriole, who is also the Robert K. Royce Distinguished Professor.

Dr. Andriole believes current guidelines for men to have baseline screenings at age 50 need to be replaced with a more selective approach, with only those men at high risk of prostate cancer being screened on a regular basis.

He recommends baseline screening with both PSA test and DRE at age 40 for men at high risk.

This includes black men and those who have a family history of prostate cancer. 

Previous results from this study, published in the New England Journal of Medicine in 2009 were inconclusive.

"We have to take a more nuanced approach to determine which men should be screened with PSA in the first place, how frequently they should be tested, the PSA level at which they should be biopsied and whether their cancer warrants aggressive therapy," Dr. Andriole said.

This study reaches essentially the same conclusions as those of the U.S. Preventive Services Task Force, which called for an end to regular PSA testing for men healthy 50 and older in good health.

The USPSTF concerns were that the screenings didn't save lives and could lead to more invasive and aggressive treatments that can result in debilitating side effects.

Researchers will continue following men enrolled in this study for up to 15 years to learn more about the impact of screenings on mortality.

Updated study findings were published online January 6, 2011 in the Journal of the National Cancer Institute.

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Review Date: 
January 6, 2012