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Prostate Cancer: As Screening Dips, Concerns Rise

by Amanda Conschafter, blog editor

Fewer men are being diagnosed with prostate cancer, new data shows—perhaps because fewer are being screened. The dip follows 2012 recommendations from The U.S. Preventive Services Task Force that men not at high risk should avoid the prostate-specific antigen test used to detect the disease. Screening, the task force argued, often led to radiation, surgeries and side effects unnecessarily because many patients would outlive prostate cancer’s slow growth.

Health care providers and medical organizations are ambivalent about the new trend, media outlets report. David Penson, MD, of Vanderbilt University’s department of urologic surgery called the decline in screenings “very disturbing.” Yet Howard Brody, MD, of the University of Texas at Galveston saw a “much greater chance that a PSA test would lead to preventable misery such as impotence or incontinence, compared to any chance of having one’s life saved.”

The new data also raises concerns about protecting the physician-patient relationship in making a screening decision. As the American Cancer Society’s chief medical officer explained, “It’s only a good thing if [the numbers] went down because doctors and patients consciously decided together that it shouldn’t be done.” David Penson echoed the need for a personalized approach in a recent Journal of the American Medical Association article. “It is time to accept that prostate cancer screening is not an all or none proposition and to accelerate development of personalized screening strategies that are tailored to a man’s individual risk and preferences,” he wrote.

Dr. Penson explained that the task force’s 2012 guidelines relied heavily on two studies that demonstrated the dangers of over-diagnosis and overtreatment. He noted that research also exists to corroborate the benefits of screening.

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