It is said that most men will have prostate cancer if they live long enough, but screening for the disease has been controversial. Yesterday, cancer specialist group American Society of Clinical Oncology (ASCO) released a statement advising that prostate cancer screenings should be undertaken – for some men.
The organization said that doctors should discuss the pros and cons for screenings with their patients. They added that screenings should not be conducted for people who are not expected to live for another 10 years, because the risks outweigh the benefits.
Screening for prostate cancer has been a contentious issue in scientific circles. The U.S. Preventative Task Force (USPTF) advised against regular prostate screenings, saying that men have suffered from incontinence, impotence, heart attacks, and even death as a result of the treatment of tumors that would not have killed them.
Prostate cancer screenings look for the prostate-specific antigen, or PSA. The trouble with the screening is that it has been too successful. Elevated levels of PSA can lead to biopsies, surgeries, and radiation – all of which are increasingly expensive and potentially unnecessary, as the test cannot differentiate between an enlarged prostate or prostate cancer. What’s more, in some men, the cancer would have been slow-growing or would not grow at all – meaning that such aggressive intervention would have been unnecessary.
The ASCO and the USPTF panels both examined two studies undertaken in the United States and in Europe, which provided mixed results. In the American trial, they found no difference between those who were screened systematically and the control group, but that study drew criticism because some in the control group were also screened. In Europe, they found that screening helped – but only slightly – and that it did not seem to help save lives.
The trials also found that four out of 1,000 men who receive screening will die of prostate cancer, compared to five of 1,000 men who will die but did not receive screening. Three-quarters of the positive tests will be false positives.
Prostate cancer is the second-largest killer of men in the United States today, with 28,000 deaths and 240,000 new diagnoses annually.