Task Force Says Men Age 75 and Older Should Not Be
Screened for Prostate Cancer
Chances are they will die of something else before
the cancer gets them
Aug. 5, 2008 - Men age 75 and older should not be
screened for prostate cancer, because even if they have it, chances are
they will die of something else first, as well as endure pain and
suffering from the testing. Younger men should discuss the benefits and
harms of the prostate-specific antigen (PSA) test with their clinicians
before being tested, according to new recommendations from the U.S.
Preventive Services Task Force.
The Task Force found evidence that screening for
prostate cancer provided few health benefits but led to substantial
physical harms and some psychological harms in men age 75 and older.
In men younger than 75, the Task Force concluded
that current evidence is insufficient to assess the balance of benefits
and harms of prostate cancer screening. An estimated 218,890 U.S. men
were diagnosed with prostate cancer in 2007, and one in six men will be
diagnosed in his lifetime.
Screening for prostate cancer is most often
performed using PSA tests and digital rectal exams. The PSA test is more
likely to detect prostate cancer than the digital rectal exam. However,
prostate cancers that are found with a PSA test take years to affect
health; most prostate cancers that grow serious enough to cause death
take more than 10 years to do so.
Since a 75-year-old man has an average life
expectancy of about 10 years and is more likely to die from other causes
such as heart disease or stroke, prostate cancer screening is unlikely
to help men over 75 live longer.
For the same reasons, men younger than 75 with
chronic medical problems and a life expectancy of fewer than 10 years
are also unlikely to benefit from screening.
There are also harms associated with prostate
cancer screening, which include biopsies, unnecessary treatment and
false-positive results that may lead to anxiety. Complications often
result from treating prostate cancer and may include urinary
incontinence and impotence. These slow-growing cancers may never have
affected a patient's health or well-being had they not been detected by
screening.
"Because many prostate cancers grow slowly, early
detection may not benefit a patient's health and in some cases may even
cause harm," said Task Force Chair Ned Calonge, M.D., M.P.H., who is
also chief medical officer for the Colorado Department of Public Health
and Environment.
"We encourage men younger than 75 to discuss with
their clinicians the potential—but uncertain—benefits and the possible
harms of getting the PSA test before they decide to be screened."
The recommendation and accompanying evidence
summary appear in today’s issue of the Annals of Internal Medicine.
Current data show that one-third of all men in the
United States over 75 are receiving PSA testing. Although most major
medical organizations suggest that prostate cancer screening may be
discontinued in men with a life expectancy of fewer than 10 years, the
Task Force is the first group to define an explicit age cutoff above
which screening is likely to be ineffective or harmful.
The results of two ongoing clinical trials—the
National Cancer Institute's Prostate, Lung, Colorectal and Ovarian
Cancer Screening Trial and the European Study of Screening for Prostate
Cancer—should help to clarify the potential benefits of screening in men
under the age of 75.
The Task Force is the leading independent panel of
experts in prevention and primary care. The Task Force, which is
supported by AHRQ, conducts rigorous, impartial assessments of the
scientific evidence for the effectiveness of a broad range of clinical
preventive services, including screening, counseling, and preventive
medications. Its recommendations are considered the gold standard for
clinical preventive services.
Previous Task Force recommendations, summaries of
the evidence, and related materials are available from the AHRQ
Publications Clearinghouse by calling (800) 358-9295 or sending an
E-mail to
ahrqpubs@ahrq.hhs.gov. Clinical information is also available from
AHRQ's National Guideline Clearinghouse™ at
http://www.guideline.gov.
For men who have been diagnosed with prostate
cancer, AHRQ has two new plain-language guides that compare the
effectiveness and risks of prostate cancer treatments. More information
about the guides is available at
http://www.effectivehealthcare.ahrq.gov.
Internet Citation:
Task Force Says Men Age 75 and Older Should Not Be
Screened for Prostate Cancer. Press Release, August 4, 2008. Agency for
Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/news/press/pr2008/tfproscanpr.htm
