An influential medical panel is recommending that the decision to screen middle-aged men for prostate cancer be left up to patients and their doctors, reversing previous advice to avoid regular screening altogether.
The U.S. Preventive Services Task Force, a government-appointed panel that makes healthcare recommendations, had advised against regular screening because of the risks it carried: Treatment for prostate cancer often leaves men incontinent or with erectile dysfunction and doesn’t help them live longer. Without treatment, many men who have prostate cancer do not develop any symptoms.
But the latest advice also points to studies that have discovered that certain men, including black men and men with a history of prostate cancer in their families, do have a higher risk of developing prostate cancer that is more lethal. The panel advised doctors to keep that in mind when discussing the pros and cons of screening with their patients, and to let them know when they have more likelihood of developing cancer.
Men who are ages 70 and up should not be screened at all because the costs outweigh the benefits, the panel determined. Decisions about the pros and cons of testing for prostate cancer or treating it apply to men between the ages of 55 and 69, and not beforehand because the risk is low. Roughly 13 percent of men are diagnosed with prostate cancer, and 2.5 percent die from it in the U.S.
“Prostate cancer is one of the most common cancers to affect men and the decision whether to be screened is complex,” said Alex Krist, vice chairman of the task force. “Men should discuss the benefits and harms of screening with their doctor, so they can make the best choice for themselves based on their values and individual circumstances.”
Testing for prostate cancer involves looking for elevated levels of a certain protein known as PSA in the blood. Medical experts have been concerned about the test, however, because it not only is a signal for prostate cancer but for less serious prostate problems, such as inflammation. Even when cancer is detected, there isn’t a way to tell whether it will become aggressive and spread or whether it will grow slowly and cause no problems. Testing following PSA results requires a biopsy, which carries a risk of infection.
In cases when a biopsy is performed and cancer is detected, patients have to weigh whether they want treatment, which often involves radiation and surgery and can leave men incontinent or impotent. An alternative to treatment involves regular checkups so that men can either delay surgery or avoid it altogether.
