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9 January 2012
No benefit from routine prostate cancer screening
by George Atkinson

A long running trial into the effectiveness of mass prostate cancer screening finds that screening does not reduce deaths from the disease. Writing in the Journal of the National Cancer Institute, the researchers noted that six years of aggressive, annual screening for prostate cancer led to more diagnoses of tumors but not to fewer deaths from the disease.

"The data confirm that for most men, it is not necessary to be screened annually for prostate cancer," says the study's lead author Gerald Andriole, chief urologic surgeon at the Siteman Cancer Center. "A large majority of the cancers we found are slow-growing tumors that are unlikely to be deadly."

The study involved men aged between 55 and 74, who received either annual PSA tests and digital rectal exams or "routine care," meaning they had the screening tests only if their physicians recommended them.

"We are learning that only the youngest men - those with the longest life expectancy - are apt to benefit from screening. We need to modify our current practices and stop screening elderly men and those with a limited life expectancy," says Andriole. "Instead, we need to take a more targeted approach and selectively screen men who are young and healthy and particularly those at high risk for prostate cancer."

The researchers recommend that men get a baseline PSA test in their early 40s as elevated levels at that age can predict the risk of prostate cancer in later years. Men in their 40s with low PSA levels are very unlikely to develop lethal prostate cancer and could potentially avoid additional testing.

Andriole says that widespread testing has lead many men with slow-growing tumors to be over-diagnosed and over-treated with surgery or radiation therapy, the possible side effects of which include incontinence and impotence. "We have to take a more nuanced approach to determine which men should be screened with PSA in the first place, how frequently they should be tested, the PSA level at which they should be biopsied and whether their cancer warrants aggressive therapy," he concluded.

Discuss this article in our forum
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Source: Washington University School of Medicine

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