Screenings for and Diagnoses of Prostate Cancer Falling

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Two studies found that fewer men in the United States are screened for prostate cancer, as well as fewer being diagnosed.

The question the research does not answer is whether this is a positive step or negative.

Typically, men undergo the prostate-specific antigen (PSA) test at age 50. In 2012 though, the U.S. Preventive Services Task Force for the federal government cited evidence that these screenings can do more harm than good. Prostate cancer grows slowly and only rarely advances to a state that can be life threatening. Thus, early diagnosis could theoretically lead to unnecessary surgery or treatments that can leave lingering side effects.

One of the two studies was with the American Cancer Society. Researchers found that the number of men age 50 or older who had a PSA screening fell from 41 percent in 2008 to 31 percent in 2013.

The diagnoses fell similarly, but it is unclear whether the reduction in diagnoses is caused by the reduction in tests, or whether there really are fewer cases.

The second study examined screening rates only but found a pattern similar to that found in the first study.

The conclusions of both studies show that patients and doctors alike are beginning to understand the lack of clarity around whether screenings save lives.

One issue is that the screenings more likely diagnose the type of prostate cancer that is a threat than is a threat.

Only two of 11 completed clinical trials that tested effects of PSA tests found benefits. All 11 showed possible harms with the screenings.

The study suggests we could be missing potential patients with the existing screening, such as those 10 years younger than the suggested screening age who may end up with incurable cancer in the future.

Though screenings may have been overused in the past, it’s possible the pendulum is swinging too far in the opposite direction. The fear is an increase in mortality due to prostate cancer.

Additional research to define high risk is important. One study in Sweden, for example, concluded PSA levels in a man’s 40s could predict prostate cancer risk.

Men who are found to have nonaggressive, small tumors need not undergo treatment immediately, but instead can opt to actively surveille the cancer over time with PSA tests or biopsies.

Speak with your doctor about the risks and benefits of PSA screening by age 50, if not before.

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