Prostate Screening Drops Sharply, And So Do Cancer Cases : Shots - Health News A decrease in PSA testing came after a controversial recommendation against routine screening. As a result, many fewer cases of the most common cancer to hit men are being diagnosed, research finds.
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Prostate Screening Drops Sharply, And So Do Cancer Cases

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Prostate Screening Drops Sharply, And So Do Cancer Cases

Prostate Screening Drops Sharply, And So Do Cancer Cases

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ARI SHAPIRO, HOST:

And now an item about the most common cancer to hit men in America. New research out today finds the rate at which men are getting screened for prostate cancer has dropped significantly, and that's re-igniting the debate about how best to fight it. NPR health correspondent Rob Stein reports.

ROB STEIN, BYLINE: For years, doctors recommended men routinely get a test called a PSA to catch prostate cancer as early as possible. But Otis Brawley, of the American Cancer Society, says that changed when an influential panel of experts basically said, wait a minute.

OTIS BRAWLEY: The U.S. Preventive Services Task Force recommended against routine use of PSA screening.

STEIN: The task force concluded mass screening was doing more harm than good, that there wasn't much evidence that PSA testing was saving a lot of men's lives and there was plenty of evidence it was hurting them.

BRAWLEY: There's considerable harms associated with screening - people who die as a result of needless treatment, people who end up with urinary incontinence, meaning they have to wear diapers, men who are rendered sexually impotent.

STEIN: So the Cancer Society and another group of researchers decided to take a look at what happened after that recommendation to scale back on PSA testing. They analyzed data collected by big government health surveys and found screening dropped sharply after the recommendation changed.

BRAWLEY: The take-home message to me is that the American public actually did listen to the U.S. Preventive Services Task Force, doctors listened to the Preventive Services Task Force when they talked about how there are harms associated with PSA screening.

STEIN: The big question is, is that good or bad? Well, that recommendation to do less screening is hugely controversial. Critics charge more men will die from prostate cancer by not spotting it early. So for the critics, the drop in PSA testing is setting off alarm bells.

DAVID PENSON: I think it's very disturbing.

STEIN: David Penson is a urologist at Vanderbilt University. He says less screening means missing a lot of tumors when they're really small and easier to beat.

PENSON: We're going to catch patients at a point where we can't cure them of their cancer, and ultimately we're going to see increasing mortality rates in prostate cancer.

STEIN: In fact, the Cancer Society study did find a big drop in the number of men being diagnosed early with prostate cancer. About 33,000 fewer men are being diagnosed every year now. That's what doctors like Penson have been worrying might happen.

PENSON: Prostate cancer screening is certainly not perfect, but it doesn't mean we should throw the baby out with the bathwater, which is exactly what's occurred here. If your loved one died because there was no screening, this makes a big difference to you. There is a human cost to this recommendation.

STEIN: But does that really mean more men will die from prostate cancer because of less screening? Many experts say there's little or no evidence screening actually saves lives.

MICHAEL LEFEVRE: I do appreciate how foreign that sounds in terms of our conceptualization of what cancer does.

STEIN: Michael LeFevre was on the Task Force when it made that controversial recommendation back in 2012. He says a lot of prostate tumors grow very slowly or never grow at all.

LEFEVRE: Not all of the cancers that we find actually need to be treated or are a threat to a man's health. Most prostate cancers will not, in fact, go on to cause harm, and so you end up dying from something else before they ever become apparent.

STEIN: But LeFevre and others acknowledge no one knows for sure what's going to happen to the prostate cancer death rate until more time has passed and there are some men who should routinely get screened because they're at greater risk for prostate cancer for some reason. So in the meantime, everyone agrees that the most important thing is that each man talk to his doctor to find out whether PSA testing is a good idea for him or not. Rob Stein, NPR News.

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