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Federally-sponsored task force recommends against prostate screening for men

The United States Preventative Services Task Force issued a recommendation this week that men not undergo routine prostate cancer screening.  So-called PSA or prostate-specific-antigen testing has become routine with many physicians and is now a very lucrative business for the manufacturers of the test, the labs who process tests, and the doctors who treat prostate cancer.  Nevertheless, the Task Force called for elimination of routine screening and cited five well-controlled clinical trials to support its conclusion that PSA screening does not save lives and does cause untold misery to many men.

The Task Force explained that current PSA tests do not distinguish between benign cancers and likely fatal prostate cancers, and that an overwhelming majority of the prostate cancers detected would never become fatal.  By some estimates, more than fifty patients must be treated for prostate cancer in order to successfully treat one likely-fatal cancer.  Since the treatment (including surgery, radiation and chemotherapy) is extremely intrusive, causes significant complications and is sometimes fatal, the statistical evidence supports the conclusion  that men are better off NOT knowning that they may have a [most likely] slow-growing, non-fatal tumor.

A professor at Baylor College of Medicine who chairs the Task Force explained that "unfortunately, the evidence now shows that this test does not save men's lives...[it] cannot tell thedifference between cancers that will and will not affect a man during his natural lifetime. We need to find one that does."  Thus far, studies have failed to support the claim that early treatment of the aggressive form of prostate cancer is effective.

The Task Force also noted that rectal exams and ultrasounds are equally ineffective in alerting patients to dangerous cancers and distinguishing them from relatively benign tumors.  From 1986 to 2005, more than one million men were subjected to prostate cancer surgery, radiation therapy or both, solely in response to a PSA screening test.  Among those patients, 5,000 died within days or weeks of surgery, and between 10 and 70 thousand suffered serious complications.  Half exhibited persistent blood in their semen and almost 1/3 were rendered impotent, incontinent or both.  The man who developed the PSA test and has since recommended against screening, terms his invention "a public health disaster."

Since one man is six will eventually be diagnosed with prostate cancer;  and since more than 200,000 men are diagnosed annually and 32,000 men die annually from the disease, the recommendation against screening is not likely to take hold any time soon.  Autopsy studies show that one-third of men between 40 and 60, and 3/4 of men over 85 suffer from some degree of prostate cancer on autopsy.  The trials relied upon by the Task Force show that screening patients does not meaningfully alter the ten-year survival rate for patients:  a few patients with aggressive cancer will die, either way, and the vast majority with relatively benign cancer will die of something else.

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