Earlier this month, the American Cancer Society modified its prostate cancer testing recommendations, following the publication of two studies highlighting the limits of the digital rectal exam and PSA testing for prostate cancer. Doctors now should emphasize the limits and risks, as well as benefits, of prostate screening to patients before doing the tests, and make the digital exam optional, the cancer society said. But not everyone agrees with the new recommendations.
Dana Wilbourn said he understands new guidelines from the American Cancer Society that emphasize the limits of prostate cancer screenings.
But the 57-year-old retiree from East Brainerd, Tenn., who has prostate cancer, said that, in his case, the blood test offered a critical warning sign.
At age 50, a routine prostate-specific antigen -- or PSA -- test revealed he had slightly elevated levels of a protein produced by the prostate, which can indicate a simple infection or the presence of cancer. In subsequent readings, the level only grew, leading to a biopsy and a diagnosis of cancer at age 52.
Though he is still battling the disease even after prostate removal surgery, chemotherapy and radiation, Mr. Wilbourn said he's thankful the cancer was caught in 2004.
"If we had just started talking about prostate cancer instead of just started testing for it when I was 50, then I could have been in more trouble than I am now," he said.
Still for others, particularly those who don't have a family history of prostate cancer like Mr. Wilbourn, the benefits of routine and early screening are less clear, and the potential for unnecessary treatments is high, experts said. For men with low PSA levels, an exam every two years is recommended instead of annually, the society said. Local urologists said they agree with the need for more patient education about screening and more judicious use of screenings. "I'm not surprised" by the new recommendations, said Dr. Patrick Foley, urologist with Plaza Urology Group in Chattanooga. "Those of us that treat prostate cancer see that it's probably overtreated. There does need to be a little more caution in screening patients for prostate cancer." In 2009, more than 27,000 men died from prostate cancer, according to the National Cancer Institute. The American Urological Association, urologists' professional organization, is sticking to its guidelines of calling for a baseline PSA test at age 40 and follow-ups depending upon the individual patient. The American Cancer Society cited two studies that prompted the change. One study of 76,000 men found little difference in cancer death rates between those who received an annual PSA and digital rectal examinations and those who didn't. Preliminary results of a European study of 182,000 men found that screening reduced the rate of prostate cancer death by 20 percent, but that to prevent one death, 48 men would have to be treated.
Dr. Lee Jackson, urologist at Memorial Hospital, said that, even though the information that can be gleaned from a PSA screening is limited, when used appropriately, it can save lives. "The consequences of missing this are huge," Dr. Jackson said, adding, "The consequences of overtreating are considerable as well." Treatments for prostate cancer, such as prostate removal surgery, can result in incontinence and erectile dysfunction. Prostate cancer is often slow-growing and may never affect a man in his lifetime, doctors say. Still, many men find it hard to forgo aggressive treatment in favor of the "active surveillance" their doctor might recommend instead, local urologists said. "Once you say the words, 'You have prostate cancer,' ... their life will literally flash before them and it's difficult for them to understand that it's not as terrible as it sounds all the time," Dr. Foley said. Comparative EffectivenessResearchers are looking more closely at prostate screening protocols and the evidence behind their effectiveness. Last year, an article published in the Journal of the American Medical Association concluded that, after 20 years of screenings for breast and prostate cancer, there has not been a significant decrease in the diagnosis of late-stage cancers, despite an increase in the diagnosis of early-stage cancers.
The study's authors said the results suggest that screenings are finding more low-risk cancers that might not otherwise have been diagnosed, but that screenings aren't detecting many of the aggressive cancers that become fatal. In November, the U.S. Preventive Services Task Force changed its recommended age at which women should first get a mammogram from 40 to 50 and added that exams should come every two years instead of annually. Questioning accepted treatment guidelines and looking at long-term outcomes is good for the health care system, said Dr. Charles Idom, urological surgeon at Hamilton Medical Center in Dalton, Ga. "We're doing all these robotic prostatectomies and radiation therapies for prostate cancer -- is it making any difference?" he said. "We're looking at that, and I think it's healthy for the system ... that we make sure the treatments we're doing are making an impact."You might also want to read...Refiguring Cholesterol Level Targets5 Common Men's Health Issues
