Wednesday, August 6, 2008

Stop prostate exams at age 75, federal panel recommends

Side effects of cancer treatments and stress from false positives outweigh any potential benefits, the group says. There's a backlash to the recommendation among some experts. Men over the age of 75 should no longer be screened for prostate cancer because the potential harm from the test results -- both physical and psychological -- outweighs any potential benefit from treatment, a federal panel said Monday.

Most oncologists already argue against treating most men in that age group for prostate cancer because they are more likely to die from some other cause than from their tumor. The new guidelines go one step further, saying, in effect, why test if the patient is unlikely to be treated?

read article

I am a general internist, and, in the past three years, I have known two men (not my patients), one in his 80s, the other in his 90s, who were not screened and who developed florid prostate cancer with multiple painful metastases to their bones. The younger man had other health problems, but his cancer responded to hormone treatment that significantly improved the quality of his remaining years. The older man, otherwise perfectly healthy and in full possession of his faculties, died a painful and almost certainly premature death.

Defending the Prostate Cancer Blood Test

The U.S. Preventive Services Task Force, a panel of experts who guide national health care, issued its report Monday based on a review of past research. The task force found that screening can detect some cases of prostate cancer, but the benefits of treatment in men over 75 "are small to none." Treatment often causes "moderate-to-substantial harms," including impotence and bladder control and bowel problems, the task force said, without evidence it saves the lives of these elderly men.

The panel did not recommend for or against prostate screening of men under 75 but suggested that doctors discuss the potential benefits and harms of the test with their patients. "I think it's a very well done and justifiable recommendation," said Dr. Barnett Kramer, associate director of disease prevention at the National Institutes of Health. "They continue to say the jury is still out for men under 75."

read article