Task Force Advises Against Prostate Cancer Screening for Men Over 75

The U.S. Preventive Services Task Force has announced a new recommendation that men age 75 and older should not be screened for prostate cancer. In addition, younger men are advised to discuss the benefits and harms of the prostate specific antigen (PSA) test with their healthcare providers before being tested.
The Task Force recommendations are supported by findings that screening for prostate cancer offers few health benefits and can lead to considerable health problems such as erectile dysfunction, urinary incontinence, bowel dysfunction, and death for men age 75 and older, in addition to experiencing the pain and discomfort associated with prostate biopsy.
The panel found that some men with prostate cancer who receive treatment would never have developed symptoms related to cancer during their entire lifetime. Others have suffered psychological effects from false-positive test results. For men under the age of 75, the group has concluded that evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening.
Prostate cancer is the most common non-skin cancer and the second leading cause of cancer death in men in the United States. There were an estimated 218,890 men were diagnosed with the disease in 2007 within the U.S. It is also estimated that one in six men will be diagnosed with the disease within his lifetime. Older men, African-American men, and men with a family history of prostate cancer are at increased risk for developing prostate cancer.
The most common screening methods used to detect prostate cancer are PSA tests and digital rectal exams. The PSA test is the more accurate detection method of the two. However, cancers detected by a PSA test take years to affect a patient's health. It can take more than 10 years for cases to become serious enough to become terminal. Because a man who is 75years of age has an average life expectancy of approximately 10 years, he will be more likely to die from conditions such as heart disease or stroke than from prostate cancer. This would make a prostate cancer screening highly unlikely to prove beneficial for men over 75, yet currently, one-third of all men in the United States over 75 are receiving PSA testing. Additionally, men younger than 75 who suffer from chronic medical problems and have a life expectancy of less than 10 years are also unlikely to benefit from the cancer screening.
Task Force Chair Ned Calonge, M.D., M.P.H., chief medical officer for the Colorado Department of Public Health and Environment, said, "Because many prostate cancers grow slowly, early detection may not benefit a patient's health and in some cases may even cause harm." Calonge also noted, "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."
The Task Force is the leading independent panel of experts in prevention and primary care and the group is the first to identify a precise age cutoff at which screenings become ineffective or detrimental. Recommendations by the task force are considered the gold standard for clinical preventive services.
There are currently clinical trials underway including the National Cancer Institute's Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial and the European Study of Screening for Prostate Cancer. The results from these trials will assist in clarifying any potential benefits of prostate cancer screening in men under age 75.
The recommendation and evidence summary can be found in the August 5 issue of the Annals of Internal Medicine.