Screening guidelines for prostate cancer, one of the most common cancers in men, are about to undergo a revision that applies specifically to men over 75 but should be watched by men of all ages. The U.S. Preventive Services Task Force will now recommend that men over the age of 75 should no longer be screened for prostate cancer. The findings, published in the August 5th edition of the Annals of Internal Medicine, indicate that routine screening in older men does not increase survival rates, and in fact has detrimental physical and psychological outcomes. The new recommendations are expected to change prevalent medical practices, which have made widespread screening in older men the norm.
Why is this important to men of all ages? The Task Force had no previous specific recommendation regarding prostate cancer screening, and still asserts that the benefits and risks of screening in men under 75 years of age are inconclusive. This is their first assertion of precise guidelines for prostate cancer screening, and it runs counter to the conventional practices of the medical community, which has typically widely screened all older men. In fact, roughly one-third of men over 75 are currently screened for prostate cancer.
The Task Force's recommendations should not be taken as minimizing the risk of prostate cancer. Prostate cancer affects one in six American men; it is the second-deadliest cancer for men in the U.S. But screening methods for prostate cancer are fairly sophisticated. While a rectal exam is one method used to find the disease, most widespread screening is done by testing a patient's blood for prostate-specific antigen (PSA). PSA will appear in the blood before the patient experiences symptoms, and before a rectal exam will be positive, allowing for very early diagnosis.
Prostate cancer is typically a slow-moving disease, however. When detected by PSA alone, a cancer is in such an early stage that it is unlikely to cause substantial health problems in less than 10 years. Since a 75 year-old man has a life expectancy of 10 years, he is more likely to die of another cause—for instance, a heart attack, the most common cause of death in men—before the prostate cancer. Studies estimate that as many as half of men over 75 have a form of prostate cancer significant enough to find with a PSA test and biopsy, but below the level of risk to long-term health. If the Task Force's recommendations are followed, many of them will never know they have the disease at all.
The costs of treating prostate cancer are significant. Incontinence and impotence are frequent outcomes of prostate cancer treatment; anxiety and depression are common as well. And the screening itself, even if no further intervention takes place, involves a painful biopsy and a great deal of worry. All of this treatment, the Task Force found, is directed in large part at cancers that would have appeared earlier if they were likely to be fatal. "If someone has made it to the age of 75 and they don't have an elevated PSA, the likelihood of them developing clinically significant prostate cancer in the last 10 to 15 years of their life is pretty low," Dr. Peter C. Albertsen, professor of urology at the University of Connecticut Health Center, told the New York Times. "The downside risk begins to outweigh the upside at the age of 75."
Uncertainty remains with regard to routine screening in younger men. While the Task Force issued no specific guidelines for men below the age of 75, it suggests that even younger men may want to give more thought to, and have a longer conversation with their doctors about, when to begin testing. "Because many prostate cancers grow slowly, early detection may not benefit a patient's health and in some cases may even cause harm," said Task Force Chair Dr. Ned Calonge. "We encourage men younger than 75 to discuss with their clinicians the potential but uncertain benefits and the possible harms of getting the PSA test before they decide to be screened."