To evaluate whether routine screening saves lives, the task force analyzed previous research, focusing in particular on two huge studies in the U.S. and Europe. The panel’s conclusion:
_Without screening, about 5 in every 1,000 men die of prostate cancer over 10 years. The European study found PSA testing might prevent one of those deaths, while the U.S. study found no difference.
_Of every 1,000 men screened, two will have a heart attack or stroke from resulting cancer treatment, and 30 to 40 will experience treatment-caused impotence or incontinence.
_Of every 3,000 men screened, one will die from complications of surgery.
Both the U.S. and European studies have flaws, and task force critics argue over which are most believable. And while U.S. death rates from prostate cancer have dropped over 20 years, the cancer society’s Brawley says the drop began before PSA testing became widespread. Moreover, the risk of death is the same in Europe and the U.S. even though many more American men are screened, diagnosed and treated, he said.
“We need to do a better job of using PSA wisely,” said Dr. Scott Eggener, a University of Chicago prostate cancer specialist who was disappointed the task force went so far. “Most people would agree that a well-informed, young, healthy patient should have the opportunity to talk about it with their physician.”
But he’s studying a way beyond the screen-or-not controversy: Having men with small, low-risk tumors postpone treatment in favor of “active surveillance,” keeping close watch on their tumors and treating only if they grow. More than 100,000 men a year are candidates, concluded a recent meeting at the National Institutes of Health.
That approach could “maximize the benefits of screening,” Eggener said.
Task force information: http://www.uspreventiveservicestaskforce.org/recommendations.htm
Journal’s patient summary: http://bit.ly/LbhSxH