WASHINGTON — The blood test millions of men undergo each year to screen for prostate cancer leads to so much unnecessary anxiety, surgery and complications that doctors should stop testing elderly men, and it remains unclear whether the test is worthwhile for younger men, a federal task force concluded Monday.
In the first update of its recommendations for prostate cancer screening in five years, the widely respected panel that sets government policy on preventive medicine said that the evidence that the test reduces the cancer's death toll is too uncertain to endorse routine use for men at any age, and the potential harms clearly outweigh any benefits for men age 75 and older.
"The benefit of screening at this time is uncertain, and if there is a benefit, it's likely to be small," said Ned Calonge, who chairs the 16-member U.S. Preventive Services Task Force. It published the new guidelines in the Annals of Internal Medicine. "And on the other side the risks are large and dramatic."
The task force and other groups had concluded previously that it was unclear whether the benefits of the prostate-specific antigen, or PSA, test outweigh the risks. The new review of the scientific literature found no evidence to alter that assessment for younger men but enough new data had emerged to recommend against screening for older men.
"We felt with sufficient certainty that your risk of being harmed exceeded your potential benefits starting at age 75," Calonge said.
Aggressive treatment of prostate cancer can greatly reduce a patient's quality of life, resulting in such complications as impotency and incontinence.
More than 218,000 U.S. men are diagnosed with prostate cancer and about 28,000 die of it each year. Prostate cancer often grows so slowly that many men who have the disease die from something else without ever knowing they had it.
A large Swedish study found that men age 65 and older who were treated for prostate cancer were no more likely to survive than those who were not.
"If therapy isn't providing meaningful benefit, then how could screening provide benefit?" Calonge said. "And we know that the therapy produces significant harms."
Men younger than age 75 should be counseled about the potential risks associated with the test and the lack of evidence of benefit before getting it, the panel said.
Agent Orange drives up risk, study finds
Veterans exposed to the herbicide Agent Orange are twice as likely to get prostate cancer as other veterans, University of California at Davis researchers found in a study published online by the journal Cancer.
Prostate cancer in those men also comes on earlier and is more aggressive, said Dr. Karim Chaime, the study's lead author.
The findings mean that men who worked with Agent Orange should be cared for differently, getting earlier biopsies and more aggressive treatment, he said.
About 375,000 men nationwide are on the military's registry of those exposed, and roughly one-third of them can be expected to develop prostate cancer, he said.