August 5, 2008
Over 75? New Advice: Don’t Get Prostate Test
By Robyn Shelton, The Orlando Sentinel, Fla.
Aug. 5--Men should stop getting routine blood tests to check for prostate cancer once they reach 75 because the potential harm of treatment outweighs the benefits, according to controversial guidelines released Monday.
The new recommendations are the first to set an explicit cut-off age for routine prostate specific antigen tests, or PSAs, that can catch early cases of the disease.
The U.S. Preventive Services Task Force said testing at that age does not help men live longer and elevated PSA levels often cause anxiety. In addition, treatment for prostate cancer can cause serious side effects such as incontinence, impotence and bowel problems.
"Men need to understand that prostate cancer is very common, and the majority of these cancers will progress very, very slowly, if at all," said Dr. Michael LeFevre, a task-force member and professor of family medicine at the University of Missouri. "Most of the cancers found in routine screening will never become a problem."
The group also advises men younger than 75 to discuss the risks of testing before getting an annual PSA.
The suggestions for skipping the test don't apply to men with symptoms -- only those getting routine checks.
Even so, the guidelines contradict advice from other groups, such as the American Cancer Society and American Urological Association. They say doctors should offer the tests and rectal exams annually to men starting at age 50, and even younger for those with a family history of the disease or other high-risk factors.
The groups don't suggest a specific age to stop testing, and some doctors do not want to uniformly deny men the test at 75.
"It just doesn't make any sense to me to ignore a test that could potentially give you a life-saving diagnosis," said Dr. J. Brantley Thrasher, chairman of urology at the University of Kansas Medical Center and a spokesman for the American Urological Association.
About 186,000 Americans are diagnosed with prostate cancer annually, and nearly 29,000 die from the disease. Doctors agree most cases pose no immediate danger because prostate tumors usually grow slowly. The problem is that doctors can't tell definitively which tumors are going to be more aggressive.
In compiling its guidelines, the U.S. Preventive Task Force reviewed current medical studies on PSA testing. The independent panel writes guidelines on preventive measures such as taking aspirin and getting colonoscopies. The group last examined prostate-cancer screening in 2002 and concluded there was "insufficient evidence" to say whether PSA tests were warranted.
But the panel said recent studies have shown that men should be discouraged from PSA screening at age 75 and older. In that age group, the task force said the "benefits of treatment for prostate cancer detected by screening are small to none." The guidelines were published in the Annals of Internal Medicine.
PSA tests measure prostate-specific antigen, a protein that is created normally by the prostate and also by cancerous cells. That's why PSA levels usually -- but not always -- rise in men with cancer. A healthy level varies by age and race, and doctors say it's often more important to monitor how a man's PSA level changes over time.
In practice, Thrasher said, doctors already follow a common-sense approach with the tests. Most don't offer PSAs to men with other health problems that increase the risk of dying within 10 years. But today, many men are living robust and active lives into their 80s.
"I can tell you that a good number of patients are still very healthy at age 75," Thrasher said. "They have been getting the test for many years already, and they will want to continue getting it."
When prostate cancer is found, more patients are choosing to delay treatment, doctors said. Called "watchful waiting," the men monitor the tumor's progression through frequent PSA tests but do not dive right into treatment. Doctors say patients can use PSAs, biopsies and regular exams to make informed decisions.
"Even after 80, a lot of patients decide they still want [a PSA] on a yearly basis because it just gives them peace of mind," said Dr. Stan Sujka, a urologist with M.D. Anderson Cancer Center Orlando. "They've seen a lot of their friends get prostate cancer, and they want to know for themselves."
Robyn Shelton can be reached at [email protected] or 407-420-5487.
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