Screening for prostate cancer has become controversial.
The US Preventive Services Task Force concludes that the evidence is insufficient to fully endorse prostate cancer screening in younger men and they recommend against screening for prostate cancer in men over the age of 75.
And a recent study from the National Institutes of Health found that, after 7 to 10 years of follow-up, screening men with a prostate specific antigen blood test and a digital rectal exam increased diagnosis of the disease, but did not reduce deaths.
Although common sense says that early detection is better, that doesn’t seem to always to be so in the case of prostate cancer. The phenomenon of lead-time bias clouds much of the benefit of prostate cancer screening, meaning that patients live for the same amount of time they would have had they not been screened. The earlier diagnosis only makes it look like they lived longer.
The prostate specific antigen test lacks specificity. A host of other conditions can lead to an elevated value, so many men are undergoing needless prostate biopsies for benign diseases, and exposed to potentially unnecessary treatments, like surgery and radiation, that can have side effects ranging from urinary incontinence to impotence.
It’s true that some prostate cancer deaths have been prevented. But, for most men, a thorough conversation with their doctor about the risks and benefits of prostate cancer screening is becoming increasingly imperative.
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