New American Cancer Society guidelines released Wednesday suggested that regular screening for prostate cancer may be of questionable value, and that in some instances may cause more harm than good. The guidelines are causing significant worry among individuals, health care providers and advocacy groups. The concern is understandable.
Though the cancer society has not recommended routine testing for most men in more than a decade, the PSA, or prostate specific antigen, test, along with a digital rectal exam, is employed widely. One recent study found that about 41 percent of U.S. men 50 and older currently have annual prostate cancer screenings. The value of the blood test as a diagnostic tool is what prompted Wednesday’s revision of the society’s guidelines.
The test can be confusing. They can and do detect cancer, but they also produce a high number of false positive results that can lead to unnecessary biopsies and treatments than can lead to undesirable side effects, including impotence, urinary incontinence and bowel problems. That, in turn, creates an almost untenable situation for men and their health care providers.
Two recent peer-reviewed studies suggest that routine prostate cancer screening doesn’t necessarily save lives. That might be true, but individuals think in far more personal terms. Whatever the studies indicate, men worry more about their health than the broader picture. Most are aware that prostate cancer is the second deadliest after lung cancer for U.S. men. An estimated 192,000 new cases and 27,000 deaths from it were reported last year.
Those numbers rightfully concern men, who must simultaneously ponder the possibility of having a potentially aggressive and fatal cancer, consider treatment that could have painful consequences, and wonder whether a policy of watchful waiting might be the best option. Those, indeed, are difficult choices.
The new guidelines do offer some assistance in reaching a decision. The recommendation that physicians routinely discuss the benefits and liabilities of each course of action is sensible. So is the suggestion that men of average risk get detailed information about screening and its possible consequences at 50, and that men at higher risk — those with a father or brother who had prostate cancer before age 65 and African Americans — get information beginning at age 45. Those are helpful suggestions, but not definitive answers for men seeking them.
The truth is that men, in concert with their physicians, will have to weigh their medical past, their comfort level and the new guidelines when making a decision about prostate cancer screening. That’s always been the best policy. The new guidelines do not and should not change that.