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6 August 2008
PSA Test Of Dubious Benefit For Elderly
by George Atkinson

Men aged 75 and over should not be screened for prostate cancer, and younger men should discuss the prostate-specific antigen (PSA) test with their doctor before being tested, according to a new recommendation from the U.S. Preventive Services Task Force. The Task Force is an independent panel of experts that conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services.

The Task Force found evidence that screening for prostate cancer provided few health benefits but led to substantial physical harms and some psychological harm in men aged 75 and older. In men younger than 75, the Task Force concluded that current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening.

Screening for prostate cancer is most often performed using PSA tests and digital rectal exams. The PSA test is more likely to detect prostate cancer than the digital rectal exam. However, prostate cancers that are found with a PSA test usually take a decade or more to affect health. Since men at 75 have an average life expectancy of 10 years, prostate cancer screening is unlikely to help them. For the same reasons, men younger than 75 with chronic medical problems and a life expectancy of fewer than 10 years are also unlikely to benefit from screening.

The recommendation noted that there are also harms associated with prostate cancer screening, which include biopsies, unnecessary treatment and false-positive results that may lead to anxiety. Additionally, complications often result from treating prostate cancer and may include urinary incontinence and impotence. These slow-growing cancers may never have affected a patient's health or well-being had they not been detected by screening.

"Because many prostate cancers grow slowly, early detection may not benefit a patient's health and in some cases may even cause harm," said Task Force head Ned Calonge, who is also chief medical officer for the Colorado Department of Public Health and Environment. "We encourage men younger than 75 to discuss with their clinicians the potential but uncertain benefits and the possible harms of getting the PSA test before they decide to be screened."

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Routine Prostate Cancer Screening Not Beneficial
Replacement For PSA Test Mooted

Source: U.S. Preventive Services Task Force

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