A national network of cancer centers is recommending a much more aggressive approach to prostate cancer screening, including the possibility of testing all men as early as age 40. The change could affect nearly 50 million people.
The guidelines, released last month by the National Comprehensive Cancer Network, a group of 19 large hospitals that develops cancer-management and screening strategies, encourage doctors to offer prostate screening a decade earlier than what is called for in some recommendations. Doctors are not obligated to follow the group's proposals.
Prostate cancer is the second-leading cause of cancer death in men. The disease kills nearly 30,000 a year.
Some doctors note that many men already have unnecessary biopsies today. Two out of three with a suspicious score on a PSA test -- which looks for the presence of a protein called prostate-specific antigen protein -- do not have cancer. Prostate cancer treatment carries risks, experts say; it can leave up to 50% of men impotent and 10% to 20% with urinary problems or incontinence.
Other doctors predict that they will find cancers earlier, when they are more curable, by screening younger men.
The network advises doctors to offer a baseline PSA to men beginning at age 40.
The cancer network also suggests that doctors consider biopsies -- taking tissue samples to check for cancerous cells -- for men with PSA readings above 2.5 nanograms per milliliter. Today, doctors typically consider a biopsy when a man's PSA test is above 4.0.
Research shows that more than 20% of men with scores between 2.5 and 4.0 have cancer.
Deaths from prostate cancer have fallen about 20% among whites and about 16% among blacks since the mid-1990s after use of the PSA test became widespread, said William Catalona, a surgeon who is a member of the cancer network committee that drafted the guidelines.
Some doubt that PSA testing should get the credit. They note that improved treatments may help more men survive.
And clinical trials have not shown that PSA tests actually save lives, says Paul Frame, a doctor and professor of family medicine at the University of Rochester School of Medicine and Dentistry.
''We really need data to know whether we are saving lives or just putting people through a lot of misery,'' says Frame, a member of the U.S. Preventive Services Task Force.
That panel of experts has found there is not yet enough evidence either to recommend, or advise against, routine prostate cancer screening.
''Having cancer cells in the prostate is incredibly common,'' Frame says. ''The vast majority of these cancers don't progress and don't hurt anybody and don't lead to death.''
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