4/16/13, "Prostate cancer: Call to test men in their 40s," BBC, by Michelle Roberts
"Men should be offered a screening test for prostate cancer in their late 40s, researchers say.
The idea is controversial as prostate specific antigen (PSA)
testing can be unreliable, throwing up false positive results that can
cause undue worry and even treatment over something benign.But the Swedish team say checking every man aged 45-49 would predict nearly half of all prostate cancer deaths.
Their findings, in The BMJ, come from a study of more than 21,000 men.
There is no routine screening programme for prostate cancer in the UK. Men over 50 can request a free PSA test on the NHS if they wish.
In 2010, when the UK National Screening Committee in England last reviewed the issue, it again decided screening should not be introduced.
But Prof Hans Lilia and colleagues from Lund University in Sweden and the Memorial Sloan-Kettering Cancer Center in the US say there is a strong case for routine PSA testing and that men in their late-40s are prime candidates.
Screening too young - below 45 years of age - detected too few deadly cancers. And delaying screening until after a man's 50th birthday missed too many.
Screening men at the age of 45-49, however, spotted nearly half (44%) of the cancers that went on to be deadly.
In the study, 1,369 of the men had prostate cancer, 241 had advanced disease and 162 died from it.
They say all men should be offered a PSA test in their mid-to-late 40s. Those with a high result would return for frequent screening and checks (and treatment if necessary), while those with normal results could wait until their early 50s for their next PSA test.
"At least half of all men can be identified as being at low risk and probably need no more than three PSA tests in a lifetime," they say in the British Medical Journal. "This is likely to reduce the risk of over-diagnosis while still enabling early cancer detection among those most likely to gain from early diagnosis," they say.
Dr Anne Mackie, Director of NHS Screening Programmes at Public Health England, said they reviewed evidence for screening on a three-yearly basis to make sure that the programmes offered by the NHS are based on the best and most up-to-date information available.
She said they would consider the findings of the BMJ study....
The Prostate Cancer Charity said more research efforts should be channelled into finding a better screening test for the disease."
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Ed. note: BMJ (Brit. Medical Journal) link in above BBC story went to generic site, not to the relevant study.
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UK's NHS is looking better than the coming US health system at least on prostate tests which NHS provides for men 50+. US wants to eliminate PSA tests entirely per two articles below, 2012 US gov. financed study (below, 5/21/12 CNN article) and 4/16/13 Reuters article below. US sources continue to strongly oppose prostate tests citing cost isn't warranted for number of lives saved, and tests can lead to "investigation momentum" which I guess means people taking too many expensive tests:
5/21/12, "Task force: PSA tests do more harm than good," CNN, The Chart blog
"The United States Preventive Services Task Force issued their final recommendation on the PSA prostate cancer-screening test Monday, recommending against routine PSA exams for men of any age. The task force says the PSA exam and additional treatments that may follow, like radiation and surgery, result in far more harm than benefit.
Dr. Virginia Moyer, who sits on the task force, cited that only one out of every 1,000 men who are screened would actually benefit from the exam."..
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4/16/13, "PSA test leads to further procedures, harms: study," Reuters, Genevra Pittman, NY
"They said those findings point to the difficult decisions, anxiety and side effects that can come after a seemingly simple choice to undergo prostate cancer screening.
"A lot of times older men just think, ‘It's a blood test, how bad can it be?'" said Dr. Louise Walter, a geriatrician from the San Francisco VA Medical Center.
"It's not just a simple blood test and then you're done and you know if you have cancer or not and you know what to do. It's one test in a cascade of tests that can lead to increasingly intensive interventions," Walter, who led the new study, told Reuters Health.
The value of screening older men for prostate cancer has been in question for years. Last year, the U.S. Preventive Services Task Force (USPSTF), a government-backed panel, recommended against PSA tests in all men, regardless of age.
Data have been conflicting about whether screening saves any lives. It's clearer that treatment after a positive test and biopsy can cause side effects such as impotence and incontinence, and that some cancers picked up on screening would never have caused symptoms because they are so slow-growing.
For their new study, Walter and her colleagues analyzed insurance claims and medical records for almost 300,000 men, age 65 and older, who were screened for prostate cancer through the VA in 2003. Of those, just over 25,000 had a PSA level above the typical cutoff of 4 nanograms per milliliter of blood....
"The only way PSA is going to benefit anyone is, if it's high, you follow it up with a biopsy to see, do you have an aggressive cancer as well?" Walter said. Otherwise, men just live with the worry of having high PSA levels - which they wouldn't know about if they had never been screened....
"You should definitely not be screening men who say, ‘I would not want to get a prostate biopsy.'"
Of the one-third of men who did have their high PSA levels followed up on, about 63 percent were diagnosed with prostate cancer. More than 80 percent of those men chose to be treated - typically with prostate-removing surgery or radiation....
In the U.S., about 239,000 men will be diagnosed with prostate cancer in 2013 but less than 30,000 will die of the disease, according to the American Cancer Society....
Dr. Timothy Wilt, who has studied prostate cancer screening at the Minneapolis VA Health Care System and the University of Minnesota School of Medicine, said the findings support the USPSTF's recent call against PSA testing.
"What this study shows is that there are serious, frequent and often persistent harms associated with the PSA blood test and that it's not simply a blood test but that there are downstream consequences," he said.
Along with complications from treatment, the study shows about one in 1,000 men who had a biopsy died as a result, he said - cancelling out any possible small benefit from screening on cancer-related deaths.
In another research letter published alongside Walter's study, researchers found more men would choose to get a prostate biopsy after an inconclusive PSA test - which provides no information about cancer - than after not getting tested at all.
"These results suggest that the ubiquitous use of simple but unreliable screening tests may lead to consequences beyond the initial cost and patient anxiety of inconclusive results; they may also lead to investigation momentum," wrote Dr. Sunita Sah from Georgetown University in Washington, DC, and colleagues.
"The most serious harm from testing is being diagnosed with prostate cancer and nearly all those men undergo treatment, yet treatment offers little to no reduction in prostate cancer mortality in the vast majority of those men," Wilt, who was not involved in the new research, told Reuters Health.
"Making a wise decision about PSA testing can often be to say no to the PSA test," he advised. "Men should not be tested unless they have the information about the harms and the potential small benefit and make an informed decision."
SOURCES: bit.ly/15ddIUd and bit.ly/119QLNS JAMA Internal Medicine, online April 15, 2013."
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About the USPSTF which did the 2012 US study:
The first sentence on "The United States Preventive Services Task Force" website says, "The USPSTF is an independent panel of non-Federal experts..."...Yet a few sentences later it says an agency of the federal government (AHRQ, part of US HSS) is involved in all aspects of the group:
"AHRQ's Prevention and Care Management Portfolio provides ongoing administrative, research, technical, and dissemination support to the USPSTF."
The USPSTF website says it's concerned with quality of life and "not simply the identification of disease:"
"Methods and Processes
...The USPSTF focuses on maintenance of health and quality of life as the major benefits of clinical preventive services, and not simply the identification of disease." ...
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Also mentions ObamaCare ('The Affordable Care Act"):
"Recommendations
...USPSTF recommendations have formed the basis of the clinical standards for many professional societies, health organizations, and medical quality review groups.
To learn more detailed information about USPSTF recommendations, grade definitions, and topics in progress or to see a list of A and B recommendations relevant for implementing the Affordable Care Act, [ObamaCare] visit http://www.uspreventiveservicestaskforce.org/recommendations.htm."
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