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Cancer Society Casts Doubt on Value of Prostate Cancer Test

Wednesday, March 03, 2010

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New advice from the American Cancer Society puts a sharper focus on the risks of prostate cancer screening, emphasizing that annual testing can lead to unnecessary biopsies and treatments that do more harm than good.

The cancer society does not recommend routine screening for most men, a stance that hasn't changed since the mid-1990s. But its new advice goes further, to warn of the limitations of the PSA blood test that millions of American men get now. It also says digital rectal exams should be optional, rather than part of a standard screening.

Prostate cancer is the most common cancer in American men other than skin cancer. The new advice is the latest example of experts casting doubt on the value of routine screenings in the hunt for early cancers.

However, not all doctors agree with the new prostate cancer screening guidelines.

Dr. David Samadi, a Fox News contributor and chief of Robotics and Minimally Invasive Surgery at Mount Sinai School of Medicine in New York City, said he thinks the new guidelines could cause unnecessary deaths.

"In my practice, we find men in their 30s and 40s that are at high-risk and develop prostate cancer," Samadi said.

"Knowing your PSA is power, it is educational; you follow it all the time. You can find a silent prostate cancer that will not affect you, and there is a possibility to over-diagnose, but that's a risk the patient needs to take. You could also find cancer that could lead to death."

The number of prostate cancer deaths continues to decline because of regular screening, Samadi added.

"I really recommend (the age) of 40 as a baseline age," Samadi said.

The recommendations come on the heels of a government task force's recommendation last year that most women don't need mammograms in their 40s. At about the same time, a doctors group said most women in their 20s don't need annual Pap tests.

American men have long been urged to have prostate cancer screenings, but over time, studies have suggested that most cancers found are so slow-growing that most men could have avoided treatment.

A statement from the American Urological Association said it also disagreed with the new guidelines.

"(This) may cause significant confusion for patients," according to the statement. "The AUA feels there is no single PSA standard that applies to all men, nor should there be."

The Atlanta-based cancer society is perhaps the most influential group in giving screening advice. Its new guidance released Wednesday on prostate cancer urges doctors to:

— Discuss the pros and cons of testing with their patients, including giving them written information or videos that discuss the likelihood of false test results and the side effects of treatment.

— Stop giving the rectal exam as a standard prostate cancer screening because it has not clearly shown a benefit, though it can remain an option.

— Use past PSA readings to determine how often followup tests are needed and to guide conversations about treatment.

Dr. Andrew M. Wolf, associate professor of Medicine at the University of Virginia Health System and chair of the Advisory Committee, agreed with the society.

"Two decades into the PSA era of prostate cancer screening, the overall value of early detection in reducing the morbidity and mortality from prostate cancer remains unclear," Wolf said.

"While early detection may reduce the likelihood of dying from prostate cancer, that benefit must be weighed against the serious risks associated with subsequent treatment, particularly the risk of treating men for cancers that would not have caused ill effects had they been left undetected."

Prostate cancer is the most common non-skin cancer in American men. An estimated 192,000 new cases and 27,000 deaths from it occurred last year in the United States.

But it is a slow-growing cancer in many cases, and depending on a man's age, he may be more likely to die of something else. Major studies have suggested routine screening doesn't save lives and often leads to worry and unnecessary treatment.

The Associated Press contributed to this article.

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On the Net:

http://www.healthdialog.com

http://www.cdc.gov/cancer/prostate/pdf/prosguide.pdf

http://www.prosdex.com