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Adapted from the NCI Cancer Bulletin, vol. 5/no. 16, August 5, 2008 (see the current issue).
In updated recommendations, the U.S. Preventive Services Task Force (USPSTF) is advising against the routine use of prostate-specific antigen (PSA) testing to screen for prostate cancer in men age 75 and older. Published in the Aug. 5, 2008, Annals of Internal Medicine, the recommendations state that the potential harms of PSA testing for men in this age group outweigh any benefits, and that there is "adequate evidence that the incremental benefits of treatment for prostate cancer detected by screening are small to none."
For men under 75, the panel concluded that there was inadequate evidence to say whether "treatment for prostate cancer detected by screening improves health outcomes compared with treatment after clinical detection." In its report, the panel added that there is "convincing evidence that treatment for prostate cancer detected by screening causes moderate-to-substantial harms, such as erectile dysfunction, urinary incontinence, bowel dysfunction, and death. These harms are especially important because some men with prostate cancer who are treated would never have developed symptoms related to cancer during their lifetime."
The USPSTF is a panel of independent experts convened by the U.S. Agency for Healthcare Research and Quality. Opinions on this issue among urologists and prostate cancer researchers run the gamut, with some arguing that PSA testing in men 75 and older does indeed save lives.
Dr. Howard Parnes, chief of the Prostate and Urologic Cancer Research Group in the National Cancer Institute's Division of Cancer Prevention, notes that the potential harms of screening are well documented, while there is no evidence of a mortality benefit from routine PSA screening in men 75 or older, or in any age group.
The available evidence, he notes, "indicates that the benefit from treatment of a PSA-detected cancer is not likely to be seen for 10 to 15 years. But the potential harms of being treated now are immediate."
Even so, Dr. Parnes stresses, the recommendation is not an absolute. Clinicians and their patients may decide that PSA testing is the best course of action. "Every physician should still individualize care and shouldn't discriminate on the basis of age," he says.
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