With prostate cancer, as with other diseases, there has been a vigorous debate about who should be tested. Screening too many people leads to unnecessary treatment; screen too few and you miss cancers that could have been stopped. A new study points to what may be a better approach: “screen smarter.”
Back in 2012 the federal government’s chief advisory group on screening tests, known as the U.S. Preventive Services Task Force, came out against routine blood tests to detect a protein associated with prostate cancer. It said such screening was unlikely to save many lives and would lead many men to undergo harmful surgery or radiation that could make them impotent or incontinent.
Although not all doctors agreed with it, that advice had a profound impact. Two studies published last week in the Journal of the American Medical Association found that fewer men were screened for prostate cancer after a draft of the task force’s guidelines was released in late 2011 and made final in 2012. One of the studies also showed that fewer early-stage cancers were detected as the screening rates dropped. The number of early-stage diagnoses in men 50 and older fell to 180,000 in 2012 from more than 213,000 in 2011.
It is not yet known whether this drop in early-stage diagnoses has saved many men from needless treatment or is a dangerous development that will increase the death rate from prostate cancer because tumors won’t be found until they are harder to treat successfully. The answer may not be known for five to seven years.
An editorial in the journal suggested that the pendulum has swung too far against prostate cancer screening and that it is time to focus on ways to use the screening test more effectively, perhaps by reserving it for men at high risk based on such factors as race, ethnicity, age, family history and the results of rectal exams. Men facing only an average risk of dying from prostate cancer might simply have blood tests and possibly biopsies every other year and undergo surgery or radiation only if there is evidence that they have a tumor that is growing and becoming more aggressive.
Virtually all experts agree that patients who receive diagnoses of prostate cancer need to explore the options thoroughly — surgery, radiation or “watchful waiting” — before making a decision that depends heavily on what risks they are willing to take.