· An Aug. 1 Page One article about a federal task force's criticism of tests that screen for prostate cancer should have noted that William J. Catalona of Northwestern University, who voiced support for the screening, receives research funding and honorariums from Beckman Coulter Inc., a manufacturer of the tests in question.
U.S. Panel Questions Prostate Screening
Tuesday, August 5, 2008
The blood test that millions of men undergo each year to check for prostate cancer leads to so much unnecessary anxiety, surgery and complications that doctors should stop testing elderly men, and it remains unclear whether the screening is worthwhile for younger men, a federal task force concluded yesterday.
In the first update of its recommendations for prostate cancer screening in five years, the panel that sets government policy on preventive medicine said that the evidence that the test reduces the cancer's death toll is too uncertain to endorse routine use for men at any age, and that the potential harm clearly outweighs any benefits for men age 75 and older.
"The benefit of screening at this time is uncertain, and if there is a benefit, it's likely to be small," said Ned Calonge, who chairs the 16-member U.S. Preventive Services Task Force. It published the new guidelines today in the Annals of Internal Medicine. "And on the other side, the risks are large and dramatic."
The task force and other groups concluded previously that it was unclear whether the benefits of the prostate-specific antigen, or PSA, test outweigh the risks. The new review of the scientific literature found no evidence to alter that assessment for younger men. It did find enough new data to recommend for the first time against screening for older men.
"We felt with sufficient certainty that your risk of being harmed exceeded your potential benefits starting at age 75," Calonge said.
The recommendations come at a time when doctors are increasingly questioning whether many tests, drugs and procedures are being overused, unnecessarily driving up health-care costs and exposing patients to the risks of unneeded treatment.
"There is this idea that more is always better, and if a test is available we should use it," said Howard A. Brody, a professor of family medicine at the University of Texas Medical Branch at Galveston. "A lot of times, we're doing more harm than good."
The guidelines address perhaps the most important and contentious issue in men's health, and were praised by officials at several leading medical groups, including the National Cancer Institute and the American Cancer Society. But they drew strong criticism from others who are convinced that routine screening is necessary.
"I think they're really missing the boat," said William J. Catalona, a professor of urology at Northwestern University. "It's a disservice to patients. A lot of men die from prostate cancer, and there's just an overwhelming amount of evidence that screening saves lives."
Each year, prostate cancer is diagnosed in more than 218,000 U.S. men. About 28,000 die of it, making it the most common cancer and second-leading cancer killer among men.
The PSA test, which measures a protein in the blood produced by prostate tissue, has significantly increased the number of prostate cancer cases being diagnosed at very early stages. But it remains unclear whether that translates into a reduction in the death rate from the disease. Prostate cancer often grows so slowly that many men die from something else without ever knowing they had it.
Because it is not clear precisely what PSA level signals the presence of cancer, many men experience stressful false alarms that lead to unnecessary surgical biopsies to make a definitive diagnosis, which can be painful and in rare cases can cause serious complications.