Task force softens stance on prostate cancer screenings

<br>PHILADELPHIA (AP) _ A government advisory panel has dropped its objection to routine prostate cancer screenings for millions of middle-aged and elderly men, saying it is possible the tests save lives.

Monday, December 2nd 2002, 12:00 am

By: News On 6

PHILADELPHIA (AP) _ A government advisory panel has dropped its objection to routine prostate cancer screenings for millions of middle-aged and elderly men, saying it is possible the tests save lives.

The U.S. Preventive Services Task Force stopped short of recommending the exams, citing continuing uncertainty about their value. But it abandoned a 1996 opinion that said they are not effective enough to justify their cost.

Studies done over the past 10 years indicate that some and probably most tumors discovered during the screenings are so small and slow-growing they are unlikely to do any harm to patients, the panel said in Tuesday's issue of the Annals of Internal Medicine.

Some studies have indicated that when dangerous tumors do turn up, the death rates are generally the same among men who had regular screenings and those who didn't go to a doctor until they developed symptoms. Other studies have said that those who get the screenings have a higher survival rate.

Based on those mixed findings, the task force said there is not enough evidence to recommend either for or against routine screenings every year or two.

``Men should be informed of the gaps in the evidence, and they should be assisted in considering their personal preferences and risk profile before deciding whether to be tested,'' the group said.

A number of groups, including the American Cancer Society and the American Medical Association, already recommend that doctors discuss the pros and cons of screenings with their patients, and decide whether or not to do them on a case-by-case basis.

Doctors have argued over the screenings for a decade. Some say prostate cancer caught early can be treated before it spreads. Others believe the tests have led to thousands of unnecessary operations with side effects that can include impotence and urinary leakage.

Physicians have been embroiled in a similar debate over other types of cancer screenings. Several recent studies have raised questions about the effectiveness of breast self-examinations and mammography, noting that death rates among women who had the screenings and those who didn't appear to be similar. Other studies have reached the opposite conclusion.

About 57 percent of men over 50 had a blood test for prostate cancer last year, according to the Centers for Disease Control and Prevention. About 56 percent had a rectal examination for the disease, the CDC said.

The blood test looks for levels of a substance called prostate specific antigen, PSA. Men who test positive for cancer during a PSA test or a rectal exam usually undergo a biopsy to confirm the diagnosis.

A PSA test costs less than $100. But a biopsy and follow-up examinations can run thousands of dollars more.

Dr. Leonard Gomella, chairman of urology at Jefferson Medical College in Philadelphia, said he believes the benefits of aggressive detection outweigh its costs.

``We know we are over-treating many men with prostate cancer,'' he said. ``But something is going on over the last 10 years where we are seeing the death rate from prostate cancer go down consistently, and the easiest thing to ascribe this to is the screenings.''

About 189,000 men are diagnosed with prostate cancer each year, and about 30,200 die of the disease, making it the second leading cancer killer for men, according to the American Cancer Society. More than 75 percent of cases are diagnosed in men older than 65.

The most common treatment for prostate cancer that has not yet spread is surgery. Other treatments include radiation, hormone therapy and ``watchful waiting'' _ doctors wait to see whether the tumor grows before deciding what to do.

The task force said black men, men between the ages of 50 and 70, and men with a history of prostate cancer in the family are the most likely to benefit from screening.