Middle-aged men have been getting conflicting messages about prostate cancer screening. A decade or two ago, many were regularly urged to get a blood test for prostate specific antigen; aka a PSA test. In fact, the decision was often left up to a man’s primary care provider. If the family physician ordered a PSA test along with a cholesterol check, few men argued. It seemed like a prudent precaution. In some respects the PSA test seemed to parallel the recommendation women received to get a mammogram to detect breast cancer.
A Reversal Confuses Many Men
Then the pendulum started to swing in the other direction. Men were told that a PSA test was probably inappropriate for many middle-aged guys. A government task force, discouraged routine screening a few years ago, saying that the PSA test was not very specific for prostate cancer and could lead to over treatment.
If the PSA test revealed an elevated number, it would almost inevitably lead to further tests. Many men would be urged to get a biopsy. If there was even a minimal amount of prostate cancer that could lead to what was called unnecessary treatments such as surgery or radiation.
Dying With, Not From Prostate Cancer:
One physician we regularly interviewed on our radio show insisted that most men would die with prostate cancer not from prostate cancer. What he meant was that most older men would eventually have some prostate pathology. But the vast majority of these gentlemen would die from heart attacks, strokes or accidents and never even realize that they had low-risk prostate cancer.
It turns out that 50% of men between 70 and 80 years of age will have some signs of prostate cancer in the gland (Reviews in Urology, Spring, 2008). Yet the risk of dying from the disease is very low. That said, roughly 30,000 men die from prostate cancer each year. Lung cancer is the leading cause of cancer death among men. Prostate cancer is second. For comparison, roughly 41,000 women die from breast cancer each year.
The Pendulum Swings Again:
Now, the U.S. Preventive Services Task Force has revised its recommendations. The experts suggest that men between the ages of 55 and 69 discuss the risks and benefits of prostate cancer screening with their health care provider.
For men over 70 the task force does not recommend screening on the grounds that men whose prostate cancer is detected at that age are likely to die of something else, before the cancer kills them.
The People’s Pharmacy Perspective:
We suspect that many men may find this new advice on prostate cancer screening confusing and unhelpful. Should men get a PSA test once a year or not? The task force leaves that decision up to the man and his physician.
Some prostate cancer specialists fear that a laissez faire approach to screening will mean that more men are diagnosed at a later stage of the disease. That could make it harder to treat. Remember, prostate kills nearly 30,000 men annually. It is a serious cancer.
The trouble is that we don’t have good diagnostic criteria to determine which cancers are “indolent” (slow growing and not scary) and which are likely to be aggressive and lethal.
To help you better make sense out of this very confusing topic we recommend our one-hour radio show with two of the country’s leading cancer experts.
Susan Love, MD is a breast cancer specialist. Charles “Snuffy” Myers, MD, is a prostate cancer specialist. You can stream the audio for free by clicking on the green arrow above Dr. Love’s photo. You can also download the free mp3 file and play it on your computer or smart phone. Scroll down to the bottom of the description of the show to find the link to the free mp3 file.
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