At the age of 75, men should stop getting screened for prostate cancer, according to new recommendations from a government task force. The group reported finding evidence that the benefits of treatment based on routine screening of this age group “are small to none” [AP]. Those potential benefits are far outweighed by the possible anxiety, unnecessary surgery, and harmful side effects that elderly men can experience if the screening finds early-stage prostate cancer and the patient chooses to treat it.
Most oncologists already argue against treating most men in that age group for prostate cancer because they are more likely to die from some other cause than from their tumor [Los Angeles Times]. Prostate cancer often progresses slowly, and doctors say it can take 10 years before a patient begins to show symptoms. Many doctors now advocate a “watchful waiting” approach when prostate cancer is detected, instead of aggressive treatment that can cause impotence, incontinence, and bowel problems.
The new guidelines, published in the Annals of Internal Medicine, may change a doctor’s office ritual for elderly men. Prostate screening involves a simple blood test to check for prostate-specific antigen, or PSA. Many doctors find it easier just to do a PSA test than take the time to explain the pros and cons to a patient. Patients themselves, many accustomed since their late 40s or early 50s to getting tested, aren’t always comfortable with the idea of stopping the screening once they reach older age [The New York Times blog].
But some doctors take issue with the recommendations and argue that with medical technology improving all the time, 75-year-olds can have many productive years ahead of them and should be more protective of their health. “I think they’re really missing the boat,” said William J. Catalona, a professor of urology at Northwestern University. “It’s a disservice to patients. A lot of men die from prostate cancer, and there’s just an overwhelming amount of evidence that screening saves lives” [The Washington Post].
Image: iStockphoto
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August 7th, 2008 at 4:19 pm
This week we heard that screening for prostate cancer may do more harm than good—particularly for older men. I understand that, I suppose. Prostate cancer tends to grow slowly, and the significance of test results is not entirely clear.
I worry that in a twist of logic we will generalize a very specific recommendation. I worry that the message will shift from “Men over 75 should not be screened for prostate cancer” to “No-one should be screened for prostate cancer” to (and this is the scariest part) “I shouldn’t be screened for any cancer.”
Every day in the United States more than 100 people die of colorectal cancer because they weren’t screened when they should have been. Every day.
Colorectal cancer is the second leading cause of cancer death in this country, yet a simple screening will reduce the risk of having this disease by 80% or more.
The debate about prostate cancer screening will go on for a long time. One thing is not debatable though—cancer screening in general, and screening for colon cancer in particular, saves lives.
August 13th, 2008 at 12:00 am
I always love these debates on medical care. But since medical insurance is becoming a perk available only for those in high-level white-collar or union jobs, what are the rest of us supposed to do for medical care, let alone preventive care???
The number of 47 million w/o medical insurance keeps getting quoted but this number seems to have stayed the same for at least the last 5 years. I believe that this number is significantly higher now and I am one of them. And this number does not include those with only catastrophic insurance who also cannot afford go to a doctor for preventive examinations or care.
I haven’t been to a doctor or dentist in two years because it is just too expensive to pay for the the charges and usual tests without insurance to back you up. The last prostate screening I had was over 2 years ago when I had my last physical exam (I had a medical plan at that time). I have never had a colonoscopy.
If I should develop some serious disease or sickness, by the time it is discovered, it may be because I was rushed to a hospital but will be too far advanced for me to survive it.
Basic health insurance with preventative care should be freely available to all U.S. citizens, regardless of employment!