Men
should know that they are more likely to be harmed than to benefit from
prostate cancer screening and should only be screened if they have a
strong preference for screening, a new guideline states. Image:
scibak/iStockphoto.com
One in 6 men will be diagnosed as having prostate cancer in his lifetime, but only 3 of 100 men who are diagnosed as having the disease will die of it, according to the guideline. In other words, 97 of 100 men with prostate cancer will die of some other cause. In addition, most men who die of prostate cancer are older than 75 years. Yet despite the low risk of death from prostate cancer, especially among younger men, screening—using either the prostate-specific antigen (PSA) tests or a digital rectal examination—continues to be commonplace.
Thus, the likelihood of a man benefiting from prostate cancer screening is quite limited; about 1000 men would have to be screened to save 1 life, the guideline notes. Harm resulting from testing, however, is far more common. The false-positive rate for these tests is high and men who receive a positive result may undergo further invasive tests, such as a prostate biopsy, which can lead to infection, bleeding, or hospitalization. In addition, men who are diagnosed as having prostate cancer are likely to undergo radiation or surgery. Prostate cancer surgery is associated with a small increased risk of death, a 37% increased risk of sexual dysfunction, and an 11% increased risk of urinary incontinence.
Based on these risks and the fact that few men are likely to benefit, the US Preventive Services Task Force has recommended against prostate cancer screening with the PSA test. Other guidelines reviewed by the ACP as part of their own guideline-producing process recommend that physicians talk with patients about the risks and the patient’s preferences.
The ACP recommends that physicians fully inform patients aged 50 to 69 years that they are unlikely to benefit and face a substantial risk of harm from prostate cancer screening. The group also says that screening with the PSA test should be carried out only after such disclosure has occurred and the patient has expressed a clear preference for screening.
The authors conclude that “each man should have the opportunity to decide for himself whether to have the PSA screening test.”
Moreover, the ACP advises against prostate cancer screening with a PSA test for men younger than 50 years, older than 69 years, or with a remaining life expectancy of less than 10 to 15 years.
