New Recommendation Creates Debate Over Prostate Screening
By Grace Wiltbank
Contributing Writer
To take the PSA prostate cancer test or not to take it is the nerve-wracking dilemma now facing middle aged and elderly men.
The dilemma arises from a recent report by the U.S. Preventive Services Task Force — a panel of independent experts — which concluded that healthy men should consider foregoing the long-recommended PSA test (Prostate-Specific-Antigen test) for prostate cancer because the test doesn’t save that many lives and can lead to harmful effects from surgery or other treatments. These ill effects include acute urinary and intestinal problems and erectile dysfunction.
While prostate cancer claims the lives of thousands of American men each year, the Task Force said most prostate cancers are small and very slow growing and thus are rarely fatal. The Task Force recommended “watchful waiting,” that is, regular monitoring by the patient’s doctor rather than PSA screening.
The recommendation that men consider foregoing the test has met with considerable opposition from doctors and others in the medical field.
Dr. Curtis Miyamoto, an oncologist at Temple Hospital, said in a interview in The Philadelphia Inquirer that the new recommendations not to screen “to me are excessive.”
“Part of the reason I say this,” he said, “is because in the U.S. alone there will be almost 25,000 more cases (of prostate cancer) diagnosed this year than last. The incidence is increasing and the result will be more than 33,000 deaths this year.”
Dr. Miyamoto added: “Prostate cancer is not one disease — it comes in a range of stages and aggressiveness. And, it’s wrong to make the blanket statement that men should not be screened knowing that more than 33,000 will die from it (prostate cancer) this year.”
“I admit,” Dr. Miyamota said, “there are excessive screenings for men who will never actually benefit from them, but you cannot make the broad statement that we’re not going to do this (PSA screening) anymore.”
The American Cancer Society, he said, has made the reasonable recommendation that men should be screened starting at age 50. Dr. Miyamota said the risk of prostate cancer is higher when there is a family history of the disease. With respect to ethnic groups, he said, “African Americans have the highest risk — period. That group definitely needs to be screened. And Caucasians are at a higher risk that Asians and Hispanics.”
The doctor said he himself has had the PSA test because “I’m over 50.”
Joseph K. Izes, M.D., of Horsham, PA said in a letter to the editor of The Inquirer that as a urologist he is “gravely concerned” about the Task Force’s new recommendations concerning PSA testing.
Dr. Izes wrote “these recommendations do a great disservice to men, particularly to those with a higher risk of the disease (i.e., African American men, those with a family history of the disease, the underinsured and those with limited healthcare access).” Dr. Izes said the decision to be tested “is an individual decision that men should discuss with their physician. No single standard applies to all men.”
The Prostate Cancer Foundation (PCF) — a leading philanthropic funder of prostate cancer research — issued a statement on Oct. 10 supporting “continued routine PSA screening of informed patients until new American Urological Association clinical guidelines on PSA screening are issued and disseminated.”
PCF said it strongly recommends more research into better early detection tests for prostate cancer.
However, PCF also said that the federal Task Force’s controversial recommendation “heightened awareness...of the issue of severe complications and patient suffering from the over-diagnosis and overtreatment of indolent prostate cancers.”
In addition to the emotional and physical suffering experienced by men and their families, PCF said, “A recent cost-effectiveness analysis of PSA screening estimated that the cost of diagnosis and treatment is over $5,227,306 per patient to prevent one U.S. prostate cancer death.”
Other new developments on the prostate cancer front include reported findings that saw palmetto extract is no more effective than a placebo in treating an enlarged prostate, that selenium and Vitamin E do not ward off the disease, and that in some instances Vitamin E alone can promote prostate cancer.
On the positive side is a study finding that prostate cancer victims who exercise vigorously fare better than patients that don’t.
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Contributing Writer
To take the PSA prostate cancer test or not to take it is the nerve-wracking dilemma now facing middle aged and elderly men.
The dilemma arises from a recent report by the U.S. Preventive Services Task Force — a panel of independent experts — which concluded that healthy men should consider foregoing the long-recommended PSA test (Prostate-Specific-Antigen test) for prostate cancer because the test doesn’t save that many lives and can lead to harmful effects from surgery or other treatments. These ill effects include acute urinary and intestinal problems and erectile dysfunction.
While prostate cancer claims the lives of thousands of American men each year, the Task Force said most prostate cancers are small and very slow growing and thus are rarely fatal. The Task Force recommended “watchful waiting,” that is, regular monitoring by the patient’s doctor rather than PSA screening.
The recommendation that men consider foregoing the test has met with considerable opposition from doctors and others in the medical field.
Dr. Curtis Miyamoto, an oncologist at Temple Hospital, said in a interview in The Philadelphia Inquirer that the new recommendations not to screen “to me are excessive.”
“Part of the reason I say this,” he said, “is because in the U.S. alone there will be almost 25,000 more cases (of prostate cancer) diagnosed this year than last. The incidence is increasing and the result will be more than 33,000 deaths this year.”
Dr. Miyamoto added: “Prostate cancer is not one disease — it comes in a range of stages and aggressiveness. And, it’s wrong to make the blanket statement that men should not be screened knowing that more than 33,000 will die from it (prostate cancer) this year.”
“I admit,” Dr. Miyamota said, “there are excessive screenings for men who will never actually benefit from them, but you cannot make the broad statement that we’re not going to do this (PSA screening) anymore.”
The American Cancer Society, he said, has made the reasonable recommendation that men should be screened starting at age 50. Dr. Miyamota said the risk of prostate cancer is higher when there is a family history of the disease. With respect to ethnic groups, he said, “African Americans have the highest risk — period. That group definitely needs to be screened. And Caucasians are at a higher risk that Asians and Hispanics.”
The doctor said he himself has had the PSA test because “I’m over 50.”
Joseph K. Izes, M.D., of Horsham, PA said in a letter to the editor of The Inquirer that as a urologist he is “gravely concerned” about the Task Force’s new recommendations concerning PSA testing.
Dr. Izes wrote “these recommendations do a great disservice to men, particularly to those with a higher risk of the disease (i.e., African American men, those with a family history of the disease, the underinsured and those with limited healthcare access).” Dr. Izes said the decision to be tested “is an individual decision that men should discuss with their physician. No single standard applies to all men.”
The Prostate Cancer Foundation (PCF) — a leading philanthropic funder of prostate cancer research — issued a statement on Oct. 10 supporting “continued routine PSA screening of informed patients until new American Urological Association clinical guidelines on PSA screening are issued and disseminated.”
PCF said it strongly recommends more research into better early detection tests for prostate cancer.
However, PCF also said that the federal Task Force’s controversial recommendation “heightened awareness...of the issue of severe complications and patient suffering from the over-diagnosis and overtreatment of indolent prostate cancers.”
In addition to the emotional and physical suffering experienced by men and their families, PCF said, “A recent cost-effectiveness analysis of PSA screening estimated that the cost of diagnosis and treatment is over $5,227,306 per patient to prevent one U.S. prostate cancer death.”
Other new developments on the prostate cancer front include reported findings that saw palmetto extract is no more effective than a placebo in treating an enlarged prostate, that selenium and Vitamin E do not ward off the disease, and that in some instances Vitamin E alone can promote prostate cancer.
On the positive side is a study finding that prostate cancer victims who exercise vigorously fare better than patients that don’t.
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