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9 December 2002
Routine Prostate Cancer Screening Not Beneficial
by George Atkinson

Although screening for prostate cancer is a common part of a routine checkup for American men, a new finding issued today from the U.S. Preventive Services Task Force concludes there is insufficient scientific evidence to promote routine screening for all men and inconclusive evidence that early detection improves health outcomes. The finding is published in the December 3 issue of the Annals of Internal Medicine.

The Task Force, an independent panel of experts sponsored by the Agency for Healthcare Research and Quality, reviewed studies on the effect of screening for prostate cancer using prostate-specific antigen (PSA) tests and digital rectal exams to prevent death in men over the age of 40. The Task Force found that while the tests are effective for detecting disease, there is insufficient evidence that they improve long-term health outcomes.

Over their lifetime, 15 percent of U.S. men eventually will be diagnosed with prostate cancer, three-fourths of whom will be diagnosed after age 65. A man in the United States has a 3 percent chance of dying from prostate cancer. Because many prostate cancers grow slowly, many men diagnosed with prostate cancer will die of other causes, especially men older than 65.

If clinicians opt to perform prostate cancer screening for individual patients, the Task Force recommends that they first discuss the uncertain benefits and possible harms. Benefits of the tests may include early detection of cancer, but harms may include false-positive results and unnecessary anxiety, biopsies, and potential complications of treating some early cancers that may never have affected a patient's health or well being. Potential side effects of surgery and radiation treatment include erectile dysfunction, urinary incontinence and bowel dysfunction.

"While the jury is still out on the value of routine screening to improve health outcomes, patients should talk with their clinicians to make individualized decisions," said Task Force Chairman Alfred Berg, M.D., M.P.H., Professor and Chair, Department of Family Medicine, University of Washington, Seattle. "Men will need to make this decision based on their personal preferences and values until we have better scientific evidence on whether screening is effective."

One part of a National Cancer Institute randomzied clinical trial of over 150,000 people called the Prostate, Colorectal, Lung and Ovarian Screening Trial is looking at whether, in men, screening with digital rectal examinations plus a PSA test can reduce deaths from prostate cancer. Results from this large trial, which should be available later this decade, could help clarify the benefits of prostate cancer screening.

The Task Force, the leading independent panel of private-sector experts in prevention and primary care, conducts rigorous, impartial assessments of all the scientific evidence for a broad range of preventive services. Its recommendations are considered the gold standard for clinical preventive services.

The Task Force grades the strength of the evidence from "A" (strongly recommends) to "D" (recommends against) or "I" (insufficient evidence). The Task Force found insufficient evidence that clinicians should routinely provide prostate cancer screening to those men not at high risk for the disease. In 1996, the Task Force recommended against routine prostate cancer screening for men.

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