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By Julie Steenhuysen
CHICAGO | Fri Oct 7, 2011 1:43pm EDT
CHICAGO (Reuters) - A U.S. government-backed panel recommended against routine prostate cancer screening on Friday because widespread screening for the disease causes more harm than good.
The U.S. Preventive Services Task Force had previously said there was not enough evidence to make a call on the use of prostate-specific antigen, or PSA, tests that measure levels in the blood of a protein.
The same panel caused a media storm in 2009 after it recommended doctors scale back on routine mammograms for women in their 40s and 50s.
The panel, which advises the government on health prevention measures, downgraded its recommendation on prostate cancer screening to a "D," which means it recommends against the service because "there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits."
The proposed guidelines are meant to discourage use of the test for healthy men who do not have any symptoms that might indicate prostate cancer. They do not apply to the use of PSA tests as part of a diagnostic strategy in men suspected of having prostate cancer.
High or increasing levels of PSA can indicate an increased risk for prostate cancer, but elevated PSA levels can be caused by other things too, such as infections, an enlarged prostate or even recent ejaculation.
Studies have shown that widespread use of PSA tests has resulted in high rates of false positives and overtreatment for an often slow-growing cancer that might never have caused harm.
And the treatments -- usually surgery and radiation -- are not benign. They frequently result in impotence and incontinence.
Simply being diagnosed with prostate cancer can cause anxiety and harm. A study by researchers at Harvard and Brigham & Women's Hospital in Boston last year found that being diagnosed with prostate cancer roughly doubles the risk of suicide or death from a heart attack.
MIXED RESULT ON PSA TEST EFFECTIVENESS
But prostate cancer is not harmless. It is the second-leading cause of cancer death in the United States behind lung cancer.
"The notion that prostate cancer is not a threat to the well being of men is simply wrong," said Dr. Herbert Lepor, a urology professor at New York University School of Medicine.
Results of studies looking at the benefits of widespread prostate cancer screening have been mixed, according to the conclusions of a review of studies set to be published next week but released early by the Annals of Internal Medicine.
That review, which is used by the task force to make its recommendations, noted that of the five screening trials it studied, the two largest and highest-quality studies reported conflicting results. One found screening was associated with reduced prostate cancer deaths compared with no screening in men age 55 to 69 after nine years.
The other found no statistically significant benefit after 10 years. And of the men who had three or four rounds of screening, the false positive rate was 12 to 13 percent.
"Prostate-specific antigen-based screening results in small or no reduction in prostate cancer-specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary," the report concluded.
But critics say the studies were not long enough to show a benefit and argued that there is evidence that PSA screening saves lives.
"The U.S. Preventive Services Task Force claims the screening studies fail to show benefits of screening. This is not accurate," Lepor said.
A Scandinavian study with 14 years of follow up showed prostate cancer screening cut prostate cancer deaths by 50 percent, Lepor said.
"The U.S. Preventive Services Task Force is a group of primary care physicians like pediatricians and OB/GYNs who never treat prostate cancer. They have simply misinterpreted the studies and have not seen men die of this fatal disease," Lepor said.
The guidelines had been scheduled to be released in the Annals of Internal Medicine on Monday, but leaks of the recommendations to news outlets forced the group to post the guidelines early. It was first reported by CNN on Thursday.
The recommendations will be available for a 30-day comment period before final treatment guidelines are released.
According to the American Cancer Society, about 1 man in 6 will be diagnosed with prostate cancer during his lifetime. More than 2 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.
(Editing by Jackie Frank)
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