Group Issues Guidelines for Prostate Cancer Tests

By Dr. David Lipschitz Modified: June 21, 2013 at 11:09 am •  Published: June 21, 2013
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In most men, prostate cancer screening causes more harm than good.
    A short while ago, a patient in his mid-70s came to see me, telling me how grateful he was that a biopsy of his prostate to screen for cancer was negative. He indicated that because the Prostatic Specific Antigen (PSA) values in his blood screening for prostate cancer varied, he was having the measurements done every six months. His numbers had increased from 2.7 to 3.5, and so a biopsy was done.


    Even though a value of 3.5 is in the normal range, he was told that any increase was significant, and it was better to be safe than sorry.
    Well, fortunately for him, he did not have any adverse effects, but at his age, even the American Urological Association, the oracle for urologists, no longer advises PSA measurements. And a change in values within the normal range should virtually never be an indication for a biopsy screening for prostate cancer.
    Rest assured that the physician who performed the biopsy sincerely believed that the procedure, despite mountains of evidence to the contrary, could identify a cancer and save his life. It remains hard for any dedicated physician to change lifelong habits.
    Whether it is screening tests for prostate cancer, routine stress tests to exclude coronary artery disease or annual mammograms and pap smears, years of experience and anecdotal information of lives saved lead to the continued performance of tests and procedures that are not recommended by many experts in the field.
    Following recommendations of the U.S. Preventive Services Task Force, the urological association just issued its guidelines for PSA measurements to screen for prostate cancer. They recommend against screening in men under 40. They do not encourage screening in men between 40 and 54, in those over 70, or those who have a life expectancy of less than 10 to 15 years.
    They encourage men 50 to 69 have a discussion with their physician about the pros and cons of screening. If screening is done, the association suggests every two years be considered rather than annually.
    Prostate cancer is most dangerous when diagnosed between 50 and 69 and in high-risk populations. These include black men and men with a strong family history of prostate cancer in more than one close family member. These should consider PSA testing.
    So what is the problem with PSA measurements? First, the test is very inaccurate and multiple measurements can vary widely. Thus many values above the normal range are often of no clinical relevance and a rise in value may be purely technical.
    Second, it takes a thousand PSA measurements to identify one prostate cancer. Only three prostate cancers are identified for every 12 biopsies performed, and for the majority, there is little evidence that therapy will significantly prolong life expectancy. This particularly applies to finding cancer in men over 70.
    To diagnose few prostate cancers, more than 1 million men have biopsies annually. Most are unnecessary, and complications are unacceptably high. In recent years, about 4 percent of men having a biopsy developed a serious bacterial infection that can prove fatal. On occasion, significant bleeding can occur, as can difficulties with urination.
    There are also concerns about overtreatment of prostate cancer. Thanks to robotic surgery, more and more patients with prostate cancer are being treated with prostatectomy.
    Alternatives are implanted radiation seeds and local radiotherapy. Side effects include erectile dysfunction, urinary incontinence, fecal incontinence, bleeding and urinary infections. Many patients receive therapy to lower testosterone levels, which causes weakness, osteoporosis, fatigue, memory loss and impaired quality of life.
    These side effects may well be worth it if the cancer is cured and life prolonged. But here, significant controversy exists among experts as to benefits that most believe are outweighed by the risks.
    Despite the downside of screening, prostate cancer is a major cause of death. The current concern is that available screening tests are not sensitive or accurate enough to predict those who will succumb to the disease. Fortunately, there is hope, as promising research indicates that new and better approaches to identifying prostate cancer are on the horizon.
    Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com.
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