Value of routine prostate cancer testing uncertain

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HEALTH & SCIENCE

Value of routine prostate cancer testing uncertain

Experts find that screening is effective in detecting the disease but cast doubt on whether it improves long-term outcomes.

By Stephanie Stapleton, AMNews staff. Dec. 23/30, 2002. Additional information

Washington -- The U.S. Preventive Services Task Force has concluded that there is insufficient scientific evidence to promote routine prostate cancer screening for all men and inconclusive evidence that early detection improves health outcomes.

The task force's findings are published in the Dec. 3 issue of the Annals of Internal Medicine.

"While the jury is still out on the value of routine screening to improve health outcomes, patients should talk with their clinicians to make individualized decisions," said Task Force Chair Alfred Berg, MD, MPH, professor and chair of the Dept. of Family Medicine at the University of Washington in Seattle.

The task force's recommendation was based on a review of studies regarding the effect of screening, including both the prostate-specific antigen test and digital rectal exams, to prevent death in men 40 or older. While the group found that the tests are effective in detecting the disease, it also found the evidence insufficient to show that the tests improve long-term health outcomes.

The panel urged physicians who choose to perform these tests to do so after first discussing with patients the associated uncertain benefits and possible harms. For instance, a benefit of screening may be the early detection of cancer. However, a downside is the possibility of false-positive results and unnecessary anxiety, biopsies and potential complications relating to treating a cancer that may never affect a patient's overall health.

Statistics indicate that 15% of American men eventually will be diagnosed with prostate cancer, 75% after age 65. U.S. men have a 3% chance of dying from prostate cancer mainly because it is often slow-advancing and other health problems associated with age overtake it in terms of mortality.

Meanwhile, experts say results from a large, ongoing trial could help clarify the value of prostate cancer screening. The National Cancer Institute's randomized clinical trial, the Prostate, Colorectal, Lung and Ovarian Screening Trial should be available later this decade.

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