Prostate Cancer Screening Guidelines Often Not Followed:
TUESDAY, April 24 (HealthDay News) -- In 2008, the U.S.
Preventive Services Task Force recommended against testing for
prostate cancer in men aged 75 and older, but new research finds
that almost 44 percent of these men are still being screened.
Before the 2008 guidelines were set, about 43 percent of men in
this age group opted for prostate-specific antigen (PSA) tests, but
the task force found that testing had no effect on longevity and
could result in overtreatment with adverse consequences. Meanwhile,
the task force drafted a
new set of guidelines last October that are even more
critical of PSA testing, suggesting it may not have any value for
men of any age.
"Patients and providers did not adjust their screening behavior following the last major United States Preventive Services Task Force recommendation, and the effect of the upcoming guideline needs to be monitored," said study author Dr. Sandip Prasad, a urologic oncology research fellow at the University of Chicago Medical Center.
"Many physicians and patients continue to have confidence in PSA screening to prevent death from prostate cancer, and it is incumbent upon the medical community to refine the use of this screening test to minimize overdiagnosis and overtreatment of prostate cancer without losing ground on the progress we have made against the disease," he added.
The findings were published in a letter in the April 25 issue of
Journal of the American Medical Association.
Prasad's team found that the number of older men receiving PSA
tests had actually increased to 43.9 percent by 2010. That's more
screening than in men in their 40s and 50s (12.5 percent and 33.2
percent, respectively) who are the ones most likely to benefit from
early diagnosis and treatment, the researchers said.
Only men aged 60 to 74 were more likely to get a PSA test (51.2
percent), they noted.
To gather the data, the researchers used the 2005 and 2010
Cancer Control Supplements, which are part of the annual National
Health Interview Survey.
Because patient data is self-reported, the results likely
underestimate the actual number of men getting PSA screening, the
The U.S. Preventive Services Task Force is on the verge of
issuing new PSA testing guidelines and, based on early
recommendations, the task force now believes the PSA test is
ineffective for men of any age.
"Prostate-specific antigen-based screening results in small or no reduction in prostate cancer-specific mortality," the early recommendations conclude, and is associated with "harms related to subsequent evaluation and treatments, some of which may be unnecessary."
Given that the initial public recommendation against routine
PSA-based screening generated significant controversy in the fall
of 2011, "it is unclear what, if any, changes in PSA screening will
result if this recommendation is made final," Prasad said.
Dr. Anthony D'Amico, chief of radiation oncology at Brigham and
Women's Hospital in Boston, doesn't think that age is a good
indicator of when PSA screening is appropriate.
"I'll make the same comment for Warren Buffet who is 81 and diagnosed with prostate cancer," he said. "I don't look at 75, I don't look at 50, I look at the person. People's age doesn't tell you about their life expectancy -- on average it does, but not everyone," D'Amico explained.
"We should look at an individual's life expectancy, and if it's more than 10 years that's a person who should be screened," he said.
However, the reason the rate of screening has remained the same
is because of confusion, D'Amico said.
"Doctors and patients don't know what to think, because there is evidence that PSA works in one study and that it doesn't in another, so rather than change they do what they have been doing all along," he noted.
For more on prostate cancer, visit the
U.S. National Cancer Institute.
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