MDs urged to quit prostate screens in elderly men

August 4, 2008 9:15:10 PM PDT
Doctors should stop routine prostate cancer screening of men over 75 because there is more evidence of harm than benefit, a federal task force advised Monday in the latest blow to a much scrutinized medical test. The U.S. Preventive Services Task Force, which made the recommendation, reported finding evidence that the benefits of treatment based on routine screening of this age group "are small to none." However, treatment often causes "moderate-to-substantial harms," including erectile dysfunction and bladder control and bowel problems.

The new guidance is the first time the task force has taken a position on prostate cancer screening. The last report from the task force concluded there was insufficient evidence to recommend screening for men of all ages, although some cancer prevention groups strongly disagree.

Most major U.S. medical groups recommend doctors discuss the potential benefits and known harms of the prostate screening, or PSA test, with their patients and make individual decisions. And most agree such testing shouldn't occur before age 50.

Prostate cancer is the most common cancer in American men - about 220,000 cases will be diagnosed this year. But most tumors grow so slowly they never threaten lives. There is no accurate way to tell which tumors will.

The testing and treatment of this cancer have been a long-running debate.

Earlier this year, a study found that older men who already had early-stage prostate cancer were not taking a big risk by not treating it right away. The vast majority were alive 10 years later without significantly worrying symptoms or had died of other causes.

Prostate cancer treatments are tough, especially on older men. Some doctors instead recommend "watchful waiting" to monitor signs of the disease and treat only if they worsen, but smaller studies give conflicting views of the safety of that approach.

The new guidelines from the Preventive Services Task Force were published in this month's Annals of Internal Medicine.