Recommendations, benefits and risks of prostate cancer screening – Dr. Matthew Tollefson
Screening for Prostate Cancer: Individuals May Benefit but Society May be Harmed
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Few topics in medicine have generated as much controversy and heated debate as screening for prostate cancer. It is the second most common cause of death from cancer in men with about 250,000 new cases each year.
For the past 20 years, doctors have strongly advised having an annual blood test to measure a protein called prostate specific antigen, or PSA, because it can identify the disease when it is most curable. Over the past few years, however, well-done studies have found that many of the cancers detected by PSA testing are not life-threatening meaning that those men did not need to have their cancer diagnosed and treated. In fact, treating them resulted in many being harmed due to the side effects of the different treatments used.
Across the country, there now is a growing recognition that not all men need to be treated immediately after their diagnosis, which is called Active Surveillance. Many doctors and individuals are angry at the U.S. Public Services Task force because it recently recommended against routine screening with PSA because they determined that the harms to society outweigh the benefits. A study just presented by Boniol and associates at a European Cancer meeting in Amsterdam estimated the harms and benefits for screening or not screening 1000 men and found that in order to prevent one death from prostate cancer, an additional 35 men would need to be treated and 154 additional biopsies would occur, 12 additional men would suffer from impotence and 2 from urinary incontinence. In other words, summing up the total results, more harm occurs to a large group of men than benefit.
Does this mean a man should or shouldn't get screened? The most important answer is that each man will have to decide for himself whether the small odds of benefiting from testing and treatment are worth the greater odds that they might be harmed. To make this decision, men need to be informed about the pros and cons before they are tested.
One way to think about this choice is as follows; for the man wanting to do everything possible to minimize the risk that prostate cancer will harm them, getting tested and treated is the right thing to do. The younger and healthier he is, the easier might be this choice. However, for the man who wants to maximize his quality of life and does not believe that the odds of benefiting are sufficient to offset the odds of being harmed, screening should not be done. This is particularly true for men with a life expectancy not much greater than ten years.
The controversy will remain until a new test is developed that can tell which cancers are dangerous and which ones are not. Until then we need to recognize that what is good for some individuals does not appear to be good for society as a whole. For individuals wanting more information, they can view a short video at http://www.prostatevideos.com/prostate-health/1391-2/.
Video: Screening for Prostate Cancer
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