Dec 3, 2002 4 min read

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 that 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 they weren’t effective enough to justify their cost.

Studies performed over the past 10 years indicate that “some and probably most” tumors discovered during the screenings are “clinically unimportant,” meaning they are so small and slow-growing they are unlikely to cause harm to patients, the panel said in Tuesday’s issue of the Annals of Internal Medicine.

When dangerous tumors do turn up, some studies have indicated 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. Others said those who get the screenings and enter treatment early have a higher survival rate.

Based on those mixed findings, the task force said there isn’t enough evidence to recommend either for or against routine screenings.

“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.

Doctors have argued over the screenings for a decade. Some say cancers caught early can be treated before they spread while others believe the tests have led to thousands of unnecessary surgeries with unpleasant side effects, including possible 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 examinations and mammography, noting that death rates among women who had the screenings and those that didn’t appear to be similar. Other studies have reached the opposite conclusion.

About 57 percent of men over age 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 screening for the disease, the CDC said.

Dr. Leonard Gomella, the 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.

Screening methods include rectal examinations and blood tests for an antigen specific to prostate cancer. Men who test positive for cancer during a screening usually undergo a biopsy to confirm the diagnosis.

The most common treatment for localized prostate cancer is surgery. Other treatments include radiation therapy, androgen deprivation therapy and watchful waiting – where doctors wait to see whether the tumor grows before deciding whether to pursue a cure.

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

A number of groups, including the American Cancer Society, the American Academy of Family Physicians and the American Medical Association, 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.