Prostate cancer screening is about to get a whole lot cloudier.
Published this morning in the NEJM, the results of the study by the National Cancer Institute showed that, for men who were screened with both a PSA and digital rectal exam, there was no difference when compared to men who received “usual care.”
The results confirm the suspicions that many physicians already had, namely, that screening for prostate cancer does not appear to save lives.
As I have written countless times, there are many other diseases that can raise a PSA level. Combined with the fact that physicians have to act on elevated levels, this can lead to excessive prostate biopsies, as well as treating early cancers that end up not being the ultimate cause of death. All of these procedures expose the patient to a host of side effects, including bleeding and infection from the biopsy, and impotence and urinary incontinence from prostate cancer treatment.
The study was paired with the findings from a concurrent European study, which was not quite as negative. Nonetheless, the benefit of prostate cancer screening was minimal, with “7 fewer prostate cancer deaths for every 10,000 men screened and followed for nine years.”
Already, the USPSTF is shying away from endorsing prostate cancer screening by updating their guidelines last year, no longer recommending a PSA test for men older than 75.
So, what to do if you’re a patient? I think it’s more imperative than ever not to accept the dogma that “more screening is better medicine.” If anything, the decision of obtaining a PSA test needs to be thoroughly discussed with your doctor. Suddenly, the benefits of going down the path of screening doesn’t necessarily outweigh the risks.
Many may find that counterintuitive, and to be honest, it’s a hard truth to swallow. But these findings can help counter the pervading myth that obtaining every conceivable screening test is a sure way to improve health, when in actuality, it isn’t.
Related posts:
- What’s the latest on prostate cancer and the PSA screening test?
- Prostate cancer screening in blacks, and the lack of balanced information
- Prostate cancer screening and the PSA test
- Prostate cancer screening in men over 75
- Will patients accept the limitations of prostate cancer screening?
- 15 cancer screening posts you may have missed
- Not all doctors discuss the risks and benefits of prostate cancer screening to patients
{ 5 comments }
Every month a new screening test is deemed ineffective especially if you are over 75. I think the PSA and other medical preventive screening tests are valid. False positives do occur, and this can lead to unnecessary testing as Dr. Kevin points out. Or you can choose to follow noncritical incidental findings.
I think screening tests should continue to be done regularly because they do save lives. Surely one life is worth it. Early detection can mean treatment to cure and become disease free.
Screening tests is a way to maintain health. Why wait until disease presents itself? As former Surgeon General, Jocelyn Elders, said in an interview that we are a nation of sickness instead of wellness. I say our doctors are trained to heal after disease is present, instead of maintaining wellness.
I am doing a poll on preventive screening tests until 3/31/09 at http://mypatienthandbook.blogspot.com. I want to see what the public has to say.
I say do what is best for you, and discuss it with your doctors. My life has certainly been saved (more than once) thanks to medical screening.
doctorj: “I am doing a poll on preventive screening tests until 3/31/09 at http://mypatienthandbook.blogspot.com. I want to see what the public has to say.”
Yea? You think the public opinion on a medical matter like this is useful? People seem to think smoking marijuana will cure disease, so why don’t we go with that? How about next time a child shows up with a cold we let the public decide if they should let the child be or give them antibiotics. The point Kevin is making, and it’s very valid, is that screening tests have complications and on top of that they aren’t proven to be useful. Yes, saving one life is fantastic. But what about the slew of people who had normal prostates but now have a poor quality of life due to incontinence or sexual dysfunction?
This is such a confusing topic of patients, especially if they eventually get diagnosed with prostate cancer. On one hand, screening increases disease awareness and patient education. On the flip side, false positives and negatives decrease the value and clinical utility of such tests. I guess once you’re over 75, you’re in a new category of life.
These studies really do not address the current issues facing men who have been diagnosed with early stage prostate cancer. The currently available treatments such as surgery and radiation are really barbaric (impotence, incontinence rectal/bladder radiation damage,secondary cancers due to radiation exposure, etc.). Since prostate cancer is now diagnosed at such early stages, these traditional treatments are “overkill” and more focal treatments such as high intensity focused ultrasound should be move to the forefront as firstline treatment. Research studies should focus more on less invasive therapies such as HIFU. Also, PSA is loosing its effectiveness as a screening study because the screened population has now chnnged, leading to more false positives and negatives. More effective screening tests are needed as well.
Even before PSA, false positive pathology results were common. This was based on a DRE. Which is most reliable – PSA or DRE?
Good together?
Comments on this entry are closed.