Last year, the American Cancer Society revised its recommendations about prostate cancer screening. They changed from advising men 40 and over to get a regular check-up to a more cautious suggestion of discussing your risk level with your doctor to determine whether an exam is warranted. Now, there is further research backing up the determination that prostate cancer screenings can potentially be more harmful than helpful.
This study took place at the South-East Region Prostate Cancer Register in Norrkoping, Sweden1 over the course of 20 years. Beginning in 1987, the researchers examined more than 9,000 men in their 50s and 60s. Approximately 1,500 of those men were selected to undergo a prostate screening every three years. The first two of those tests were the digital rectal examinations that were the standard at that time and the remainder performed were prostate specific antigen testing (PSA) — the preferred method of testing in the medical community today.
After 20 years of screenings for these volunteers, there was virtually no difference in the mortality rates between the men who were tested every three years and the others who did not undergo prostate examinations at all. The problem lies in the fact that the PSA testing is so incredibly unreliable. Studies have shown that approximately 15 percent of men whose PSA levels are in the normal range in testing actually have prostate cancer. And 66 percent of men whose PSA levels are deemed high do not have prostate cancer. PSA levels may be elevated by infection, inflammation of the prostate, or a benign enlarged prostate. Needless to say, this leads to lots of men undergoing unnecessary treatments and some men who could potentially benefit from treatment not receiving it.
But the problem extends beyond the questionable accuracy of the test. There’s also the fact that even when it does detect prostate cancers, in many cases, the finding is actually irrelevant. Screening is no longer recommended in the United States for men over 75 because most prostate tumors are slow growing, especially in older men. By that age, men will almost certainly die of other causes before their prostate tumor kills them, most likely before they experience symptoms — even if they haven’t received treatment.
Research has shown that up to 44 percent of all identified cases of prostate cancer have been discovered at a point at which the disease won’t affect life expectancy. And yet plenty of older men still get screened for prostate cancer. If diagnosed, those men typically get shuttled through a series of treatments that can be debilitating, painful, and completely unnecessary.
A study conducted by the U.S. Department of Veterans Affairs that took place from 1986 through 2005 found that for every 20 men who received treatments like radiation and surgery, only one of them lived longer because of it. The researchers concluded that this has led to the superfluous diagnosis of prostate cancer in more than one million men in America. And these results were actually quite conservative compared to several other similar studies conducted in the past few years.
In other words, in most cases, it’s probably not worth your time to get a prostate screening test, at least if you’re 50 years of age or older. The side effects brought about by radiation, chemotherapy, or surgery are usually worse than anything the cancer itself causes. Even a “harmless” biopsy, performed to determine whether cancer is present after high PSA levels present, can cause such complications as urinary tract infection, blood in the urine or semen, fever, and pain.
When testing of any kind has been proven to be practically useless and in fact, is more often detrimental than beneficial, we need to think about why this screening is ever recommended anymore. The American Cancer Society doesn’t deem it a requirement; they suggest discussing it with your physician. The greatest push for PSA testing seems to come from the companies that produce the prostate cancer diagnostic test kits — the only ones who stand to lose if the screening becomes obsolete.
Incidentally, there is an updated PSA test, the Prostate Health Index, that when combined with annual biopsies, or tissue samples, seems to be about 70% accurate in singling out aggressive tumors. Unfortunately, it’s only available in Europe — still waiting for FDA approval in the U.S.
1 Sandblom, Gabriel; Varenhorst, Eberhard; Rosell, Johan; Lofman, Owe; Carlsson, Per. “Randomised prostate cancer screening trial: 20 year follow-up.” British Medical Journal. 31 March 2011. BMJ Publishing Group Ltd. 4 April 2011. <http://www.bmj.com/content/342/bmj.d1539>.