The evidence shows that at most one man in 1,000 screened will avoid a prostate cancer death over the course of 10 years. In the best U.S. study, no benefit was shown. Of the same 1,000 men screened, two to three will suffer a serious treatment complication such as a blood clot or heart attack, and up to 40 will suffer erectile dysfunction, urinary incontinence, or both. About 30 to 40 men in 1,000 will also face less serious but bothersome problems from a prostate biopsy, such as infection.
Cancer is a frightening word, but not all cancers are deadly. Prostate cancer is rarely aggressive enough to cause death within the course of a man’s natural life span. Three-quarters of men over 80 and a third of men between 40 and 60 have cancer cells in their prostates, and yet men have only a 2.8 percent lifetime risk of dying from the disease. Currently, there is no way to know which men may benefit from treatment.
Whether to be screened for any condition is a decision each person must make with his or her clinician, but we are urging health-care professionals to be forthcoming about the facts of prostate cancer, the relatively small benefit of detection, and the significant harms of screening and treatment.
To be sure, there are gaps in the existing evidence. One particular concern is that black men face a higher risk of developing prostate cancer and dying from it. The same is true for those with a family history of the disease. There is no evidence to suggest, however, that these men see an increased benefit from screening. We need more research to improve the health of men at high risk and to eliminate health disparities.
Some critics of our recommendation have suggested that we based our decision on a desire to cut costs for insurance companies and government programs. Cost was not a consideration in our evaluation of the scientific evidence. Our mission is to improve the health of all Americans with evidence-based recommendations.
The members of the task force are human; we face the same concerns and fears about health challenges that you do. This decision was not reached in a cavalier fashion. It is rooted in the knowledge that while we want to prevent deaths from prostate cancer, we need to recognize that current methods of screening and treatment are not the answer. We can do better.
Dr. Virginia A. Moyer is the chairwoman of the U.S. Preventive Services Task Force. This was distributed by McClatchy-Tribune.
