American Cancer Society urges docs about limitations of screening test for prostate cancer

ATLANTA — The American Cancer Society is urging doctors to make clearer to men that the test used to screen for prostate cancer has limits and may lead to unnecessary treatments that do more harm than good.

The cancer society has not recommended routine screening for most men since the mid-1990s, and that is not changing. But its new advice goes farther to warn of the limitations of the PSA blood test that millions of American men get now. It also says digital rectal exams should be an option rather than part of a standard screening.

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You’re right. Sorry for the lack of clarity. I meant to say that the PSA (as opposed to the digital exam) may turn up cancer that is slow growing and may be better subjected to “watchful waiting,” rather than surgery that may lead to the aforementioned complications. Although many will want the cancer out no matter what (and I would probably be one of them) some, especially those who are well past fifty, might want a more conservative approach.

Yes, I agree. It’s a complex, multi-variant decision, and in large part the individual patient has to make it without several of the variables. The big breakthrough will be the development of some way to distinguish a slow growing tumor from an agressive one. Absent knowledge of that factor, the patient will always be making a decision in the dark.

There’s a tremendous amount of research on diet, prompted in large part by the disparate rate of prostate cancer in the US versus Japan. There’s been sort of an ongoing cycle of popularity for certain supplements, with them coming into favor then later studies finding them useless. One thing that seems to have a high correlation at the moment is red meat.

I think the evolving understanding about PC will be that it’s a natural disease of aging for those who practice certain lifestyles, among them being living in a “rich” society such as ours.

I’m sorry, that was a bit succinct. Referring to your comment about not being sure of the age of those autopsied, the usual discussion has to do with those in their nineties. The percentage of them found with prostate cancer is also in the nineties. You could say that the percentage of PC in the entire male population of the U.S. roughly tracks the age of the individuals. It goes undiscovered in most because it never presents symptoms. If you just arbitrarily biopsy people with ‘normal’ PSA’s, you’ll find a lot of it, most of which the patient would have been better off if you hadn’t found. Thus, the whole screening controversy.

Interestingly enough, the National Health Service in New Zealand a few years back did an extensive study of screening from the standpoint of public health, and reached a very similar conclusion to the current ACS paper. They no longer do routine PSA screenings because, on balance, the side effects of treating cancers that weren’t going to go anywhere had a greater negative impact than waiting for symptoms to present themselves. Which is, of course, all well and good from a public health standpoint, but not much use to the individual patient who’s trying to make a treatment decision.

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