Screening younger men and men at risk of prostate cancer is beneficial and should not be abandoned, according to researchers who conducted a large new study in Europe.
The study, published in the Canadian Medical Association Journal, found that regular prostate specific antigen (PSA) screening of over 160,000 men reduced the risk of death from prostate cancer by 20 percent. The European Randomized Study of Screening for Prostate Cancer also found that PSA testing of men aged 55 to 69 years reduced the incidence of metastatic prostate cancer by 41 percent.
Rather than abandoning a screening test that reduces death and suffering, efforts should be focused on selecting patients more carefully,” conclude the authors. “Overuse of screening for unhealthy men with a limited life expectancy should indeed be discouraged; however, the same does not hold true for young healthy men.”
The researchers say elderly men with multiple medical problems should not be given PSA tests because they have little to gain from it. However, the risk to benefit ratio “shifts dramatically for healthy men with a long life expectancy.” Younger men were at lower risk of complications from a biopsy, such as erectile dysfunction, and had the most to gain from treatment if prostate cancer is found. The authors also recommend screening for men with risk factors such as black ancestry and a family history of prostate cancer.
Previous studies, such as the U.S. Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, showed no benefit in PSA testing.
Men around the world are getting conflicting advice on PSA screening. Last year the U.S. Preventive Services Task Force issued a controversial draft recommendation against PSA screening for men of all ages. However, the American Cancer Society and the American Urological Association both recommend that men be given a choice about screening.
TheUnited Kingdom and Australia also take the approach of informed choice to enable patients to make their own decisions. The Canadian Task Force on Preventive Health Care, which recommended against PSA screening in 1994, is expected to issue updated recommendations in 2013.
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