This article first appeared in the St. Louis Beacon, May 22, 2012 - A prostate cancer expert at Washington University says a federal advisory panel is misguided in recommending an end to routine prostate screening of healthy men age 50 and over. The previous guideline had called for a prostate-specific antigen (PSA) blood test or screening for most men, beginning at age 50.
Dr. Gerald Andriole, chief of urologic surgery at the Siteman Cancer Center and the Washington University Medical School, cautions that a blanket end to the screening would send men back to the time when one-third of prostate cancers had advanced and were incurable by the time they were diagnosed.
In a statement, he said, “We shouldn’t have a one-size-fits-all approach to prostate cancer screening.” While acknowledging that routine screening isn't perfect, he says, "It’s the best we have, and it would be a mistake to routinely dismiss its use.”
He also concedes that widespread screening has drawbacks, including the possibility that treatment might pose more harm than the disease. In some instances, he says, there has been over-diagnosis and aggressive treatment of slow-growing tumors.
Those drawbacks were also were cited by the U.S. Preventive Services Task Force in making its final recommendation. The panel said over-diagnosis and needless treatment had resulted in men becoming impotent and incontinent. The final recommendation came seven months after the panel drafted its initial report that gave low marks to PSA blood test, citing evidence based research.
Medical experts are divided on this issue.
"I think they're throwing away the baby with the bathwater," Dr. William Catalona, a professor of urology at Northwestern University Medical School, told U.S. News and World Report.
At the other end are physicians such as Dr. Michael LeFevre, co-vice chair of the task force and a professor at the University of Missouri Medical School. He told the magazine, "Some may say that by rating the test a 'D' we're taking away the possibility of an informed decision, but we don't want that to be the case. This decision does not preclude a man choosing to be screened."
In his statement, Andriole said routine PSA screening was unnecessary for most men. “But that doesn’t mean that some men don’t stand to benefit. We have to take a more nuanced approach to determine which men should be screened, how frequently they should be tested and whether their cancer warrants therapy.”
Andriole is the principal investigator of the National Cancer Institute’s prostate, lung, colorectal and ovarian (PLCO) screening trial. He favors leaving the decision on PSA screening to patients and their doctors. In deciding whether the screening is useful, doctors should take into consideration the patient's overall health, age and other risk factors, Andriole says.
The university says prostate cancer is the second most common cancer among men, after skin cancer. In 2011, it says that nearly 241,000 U.S. men were diagnosed with prostate cancer, and that roughly 34,00 died of the disease.
