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Recommendations for Prostate Cancer Screening

By on October 8, 2011
Doctor taking blood pressure of patient

The medical community is again divided on screening for prostate cancer. Yet, African American men may have the highest incidence of prostate cancer in the entire world. So what is a guy to do? Get informed.

Some doctors disagree with the U.S. Preventive Services Task Force, a federal government health advisory group which downgraded its recommendation on prostate cancer screening to a “D,” which means it recommends against the service because “there is moderate or high certainty that the service  has no net benefit or that the harms outweigh the benefits.”

If the recommendations are widely adopted it could have fatal results for African American men.

According to the Centers for Disease Control and Prevention website, at all ages, African-American men die of prostate cancer more often than other men do. In fact, the recommendations may increase risk for some given that Ohio State University Medical Center says that African-American men have considerably higher incidence rates (234.6 cases per 100,000 African-American men in 2003-2007) than white men (150.4 cases per 100,000 white men in 2003-2007). So why such a blanket decision by the panel? And if universally adopted, how worse would cancer rates for African American men be? Nobody knows.

The task force is said to have made its recommendation based on a review of scientific evidence that suggested the benefits of fewer cancer deaths was overshadowed by potential serious side effects from treating a cancer that might never have caused any harm.

“Prostate cancer remains the second-leading cause of cancer death in the United States,” Dr. Scott  Eggener, a surgeon who specializes in prostate cancer at the University of Chicago. He said while not perfect, PSA screening has definitely saved lives, noting that widespread PSA screening in the United States has resulted in a 30 percent decrease in death rates when adjusted for men’s ages.

High or increasing levels of PSA can indicate an increased risk for prostate cancer, but elevated PSA levels can be caused by other things too, such as infections, an enlarged prostate or even recent ejaculation. Studies have shown that widespread use of PSA tests has resulted in high rates of false positives and overtreatment for cancers that might never have caused harm.

Many physicians believe the panel recommendations are drastic.

“I think they are a little premature,” said Dr. Andrew Lee, a radiation oncologist at University of Texas MD Anderson Cancer Center.”I know some of the studies did look  bad,” Lee said. “In my personal review of the literature, there are arguments both ways. If that is the case, as a physician I would err on the side of being more conservative. “I don’t think the data is at all conclusive to make such a strong recommendation as a ‘D’ rating,” he said.

The recommendations will be available for a 30-day comment period. Note this same panel caused a media storm in 2009 after it recommended doctors scale back on routine mammograms for women. Regardless of panel recommendations, it’s always ideal to talk with your own doctor about whether you should or should not be screened for any cancer. It’s that important. Be proactive in your own health.

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