Health & Beauty
|Good Health Care News|
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March 04, 2010
Atlanta - New advice from the American Cancer Society puts a sharper focus on the risks of prostate cancer screening, emphasizing that annual testing can lead to unnecessary biopsies and treatments that do more harm than good.
|The American Urological Association - a longtime proponent of regular screening - last year backed off its call for annual tests after age 50.|
The cancer society has not recommended routine screening for most men since the mid-1990s, and that is not changing. But its new advice goes farther to warn of the limitations of the PSA blood test that millions of American men get now. It also says digital rectal exams should be an option rather than part of a standard screening.
The new advice is the latest pushback from routine screening to hunt for early cancers. Last year, a government task force said most women don't need mammograms in their 40s and a doctors group said most women in their 20s don't need annual Pap tests.
American men have long been urged to have prostate cancer screenings, but over time studies have suggested that most cancers found are so slow-growing that most men could have avoided treatment.
The Atlanta-based cancer society is perhaps the most influential group in giving screening advice. Its new guidance released Wednesday on prostate cancer urges doctors to:
• Discuss the pros and cons of testing with their patients, including giving them written information or videos that discuss the likelihood of false test results and the side effects of treatment.
• Stop giving the rectal exam as a standard prostate cancer screening because it has not clearly shown a benefit, though it can remain an option.
• Use past PSA readings to determine how often followup tests are needed and to guide conversations about treatment.
Prostate cancer is the most common non-skin cancer in American men. An estimated 192,000 new cases and 27,000 deaths from it occurred last year in the United States.
But it is a slow-growing cancer in many cases, and depending on a man's age, he may be more likely to die of something else. Major studies have suggested routine screening doesn't save lives and often leads to worry and unnecessary treatment.
The new cancer society recommendations could be "game changers" in two respects, said Dr. John Davis, a urologist who directs prostate cancer screening programs for the University of Texas M.D. Anderson Cancer Center in Houston.
First, they could change how routine physical exams for many older men are conducted, he said. About 41 percent of men 50 and older get annual prostate cancer screenings. Even though the cancer society doesn't recommend routine PSA tests, many doctors do it without even asking their patients. And there's little conversation about it unless the test gives a worrisome result. The new guidelines may spur doctors to talk to their patients earlier about the pros and cons of getting the test in the first place.
Second, the guidelines could have a chilling effect on community prostate screening clinics in which hundreds of men line up and get free, quick exams, Davis said.
That was the intent, said Dr. Andrew Wolf, a University of Virginia physician who led the group that write the new guidelines.
The American Urological Association - a longtime proponent of regular screening - last year backed off its call for annual tests after age 50. The group said men should be offered a baseline PSA test at age 40, with follow-ups at intervals based on each man's situation.
The group also has stood by the rectal exam as a standard part of screening, saying it can find cancer that the blood test does not.
The cancer society has been more cautious about regular screenings for some time. The organization last issued guidelines in 2001, which said merely that doctors should offer screening and discuss the risks and benefits.
The new guidelines back away even more, dropping the sentence that doctors should offer prostate screening. Instead, the society says some evidence indicates periodic screening can save lives but that there are significant uncertainties about the overall value of finding prostate cancer early. Screening should not take place, the new advice says, unless a patient is fully informed of the trade-offs.
Men at average risk should get detailed information around age 50, the society recommends. Men at higher risk, including African-Americans and men with a father or brother who had prostate cancer before age 65, should get the information beginning at age 45. Men with more than one close relative with prostate cancer before 65 should get such information at age 40.
For men who want to be screened regularly, the new guidelines recommend every other year if the PSA reading is less than 2.5, a measure of prostate specific antigen per milligram of blood. Annual tests are recommended for 2.5 or higher and a 4 suggests consideration of a biopsy.