Is Prostate Screening of Elderly Men Harmful?

Doctors have been advised to stop screening men older than 75 for prostate cancer.

The new recommendation is the first update by the U.S. Preventive Services Task force (USPSTF) on prostate cancer screening since 2002. Its previous report concluded that there was insufficient evidence to recommend prostate screening for men of all ages. The American Cancer Society's (Atlanta, GA, USA) advice for screening differs from that of the task force because it does not set a fixed age to stop screening. It suggests that men should not be offered screening if they are not expected to live another 10 years.

There has been a growing debate about the value of the somewhat imprecise prostate specific antigen (PSA) blood test to detect cancer, as well as the value of treating most prostate cancers. A positive result from the test must be confirmed by a biopsy. Even then, there is no foolproof method of identifying aggressive tumors from slow-growing ones. A number of experts contend patients are being over treated. The task force found that the benefits of treatment based on routine screening of this age group "are small to none." However, treatment often causes "moderate-to-substantial harm," including erectile dysfunction, bladder control, and bowel problems.

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.

Prostate cancer is the most common cancer in American men--about 220,000 cases will be diagnosed this year. It is the second leading cause of cancer deaths in men. However, most tumors grow so slowly they do not threaten lives. A study found that older men who already had early-stage prostate cancer were not taking a big risk by not treating immediately. Most were still alive 10 years after diagnosis without significantly worrying symptoms, or had died of other causes.

The panel did not recommend for or against prostate screening of men under 75 but suggested that doctors discuss the potential benefits and harms of the test with their patients. "I think it is a very well done and justifiable recommendation," said Dr. Barnett Kramer, associate director of disease prevention at the National Institutes of Health (NIH; Rockville, MD, USA). "They continue to say the jury is still out for men under 75."

Related Links:
U.S. Preventive Services Task force
National Institutes of Health
The American Cancer Society