Prostate Cancer: To Screen or Not to Screen

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By Lora Shea, Staff Writer

The debate continues on the value of cancer screening. The latest target: prostate cancer.

The American Cancer Society has issued new prostate cancer screening guidelines that encourage doctors to better communicate the risks and benefits to their patients before testing is pursued. The guidelines question the value of mass prostate screening.

M. D. Anderson urologist John Davis, M.D., says the new guidelines represent "a growing shift from the more simplistic days when doctors told men to go get screened, and we'll deal with the results as needed."

Studies show that more men die with prostate cancer than because of prostate cancer. Screening for prostate cancer may be the right choice for some men, but that decision should be made after careful consideration of a man's personal and family health history, and the risks and benefits of the specific tests. M. D. Anderson's screening guidelines affirm the need for men to discuss testing with their doctor and give specific recommendations based on a man's risk, should he decide to be tested.

The ACS guidelines also call into question the value of community screening events, in which large groups of asymptomatic men are tested. M. D. Anderson has replaced mass screening with education events for the past few years, Davis says. "These events give us the opportunity to talk to men not only about the issues around screening, but also about the variety of treatment and disease management options available to them if they are found to have prostate cancer."

Davis worries that the ACS guidelines "paint a very negative picture of prostate cancer treatment, that harm is inevitable." He says that for those properly evaluated, treatment in the right hands can offer the best outcomes.

"Furthermore, the guidelines are mostly based on two randomized trials. The American trial showed no benefit to screening, but unfortunately has numerous flaws (especially contamination between the treatment arms) and therefore is not conclusive," he says.

"On the other hand, the European study, which did not suffer from as many problems as the American trial, demonstrated a 20% lower risk of dying of prostate cancer as early as nine years from diagnosis. Given the slow natural history of prostate cancer, the percent of men who benefit from screening should go up as these patients are followed to the 15- and 20-year marks."

So who will choose to screen versus not screen? Davis predicts that "for most men who have greater than 10 years of life expectancy and work with their physicians to minimize their cancer AND cardiac disease-related risks, the result will be the well-informed decision to screen."

"Those who are not screened may be due to other more threatening health concerns, or the occasional patient who places a high personal value on avoiding any treatment-related side effects -- even if that means accepting a higher risk of dying of prostate cancer," Davis says.
If you've been screening already, should you stop? According to Davis, "The guidelines provide concise summaries of the relevant data, and it's probably best to let your screening physician talk to you about what age is best to stop."


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