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Prostate Cancer Screening: What's A Guy To Do?

Report says there's little evidence to recommend routine screening

TUESDAY, Dec. 3, 2002 (HealthDayNews) -- To screen or not to screen?

When it comes to prostate cancer, that's the question vexing doctors and middle-aged men.

Now a new study by the U.S. Preventive Services Task Force says there's insufficient evidence to recommend routine screening of men.

The task force is a government-sponsored panel of about 15 internal medicine physicians and nurses who meet quarterly to review current guidelines in preventive medicine.

The task force reviewed dozens of studies about prostate cancer that included several well-designed studies about the effectiveness of screening in preventing illness and death, says Dr. Alfred Berg, a family practice physician from Seattle and chairman of the task force.

The task force found no evidence that identifying prostate cancer early through screening reduces mortality, Berg says.

"There really is insufficient evidence to recommend for or against routine screening," Berg says. "It's not a 'yes' or a 'no.' It's a 'we can't tell.'"

The task force recommends men make the decision about screening with their doctor.

The report appears in the December issue of the Annals of Internal Medicine.

The prostate gland is an organ surrounding the tube that empties urine from the bladder. Its function is to add fluid and nutrients to semen, the fluid that carries sperm.

Prostate cancer is the most common type of cancer in men and the second most common cause of cancer-related deaths among men in the United States, according to the report.

Screening methods include digital rectal examination and a prostate-specific antigen test.

However, only 10 percent to 30 percent of men who have a positive test result actually have cancer, Berg says. That means many men may undergo the discomfort and anxiety of a biopsy that wasn't needed.

Furthermore, in many men, prostate cancer grows very slowly and never causes illness. So even if cancer cells are found, its not always clear whether surgery and radiation are called for, or if it's best to wait and monitor the condition, he says.

"Prostate cancer cells are very, very common in men as they age, but not all prostate cancer is the same," Berg says. "The problem is we don't always know which are the tumors that are going to grow and cause symptoms, and which are just going to sit there."

That means some men, hearing they have cancer, could opt for radiation and surgery when they don't really need it, Berg says. Surgery and radiation can cause impotence and incontinence, he adds.

Dr. Durado Brooks, director of prostate cancer screening at the American Cancer Society, says the task force's report is in line with the cancer society's guidelines.

The cancer society does not recommend routine screening, but suggests "men should be informed about the benefits and limitations of screening," Brook says.

"Unfortunately, prostate cancer is not a disease that one necessarily knows the best course of treatment," Brooks says. "In some cases it's clear, but in many others, we know someone has cancer, but we don't know if it's ever going to impact his life."

Some men at risk of the disease may want to strongly consider prostate cancer screening, however. These include men who have a father or brother with the disease.

The death rate for blacks from prostate cancer is 60 percent higher than for white men. However, Asian and Hispanic men are at a 40 percent and 35 percent lower risk, respectively, than white men.

What To Do

Read the U.S. Preventive Services Task Force report at its Web site. Or read more about prostate cancer screening at the American Cancer Society.

SOURCES: Alfred Berg, M.D., chairman, U.S. Preventive Services Task Force; Durado Brooks, M.D., M.P.H., director, prostate cancer screening, American Cancer Society, Atlanta; Dec. 2, 2002, Annals of Internal Medicine
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