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Researchers find decline in prostate cancer screening, early detection

While fewer patients are being overtreated, researchers fear more cancer will be caught too late to be treated.

By Stephen Feller
Researchers find decline in prostate cancer screening, early detection
Researchers said PSA testing is not all-or-none -- decisions on how early to screen for prostate cancer should be made based on a patients' unique health situation. Photo by Image Point Fr/Shutterstock

WASHINGTON, Nov. 17 (UPI) -- The number of men being screened and diagnosed with prostate cancer has declined in the last few years, according to two new studies.

Researchers in both studies call the trend worrisome because of the health risk posed to men who do not know they have cancer.

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In 2012, the U.S. Preventive Services Task Force published recommendations discouraging regular prostate-specific anitgen, or PSA, testing for men over age 50. The rationale for the changes was the number of men diagnosed but whose prostate cancer may not be life-threatening, and whose health is then challenged by surgery and treatment they don't need.

The USPTF said in its report that 90 percent of men who receive a diagnosis of prostate cancer after PSA testing receive some form of early treatment, either surgery, radiation, or androgen deprivation therapy.

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About 5 in 1000 men die within a month of surgery, between 10 and 70 of 1000 will survive some type of serious complication, and 200 to 300 of every 1000 will have some type of long-term effect as a result of the early treatment -- statistics that led the agency to suggest fewer tests be done as a protection for men who do not need treatment.

"Certainly, physicians have been overly aggressive in their approach to prostate cancer screening and treatment during the past 2 decades, but the pendulum may be swinging back the other way," wrote Dr. David Penson, a professor at the Vanderbilt University, wrote in an editorial published with the two studies. "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. By doing this, it should be possible to reach some consensus around this vexing problem and ultimately help men by stopping the swinging pendulum somewhere in the middle."

The American Cancer Society, in a study published in the Journal of the American Medical Association, found just 31 percent of men over age 50 had a PSA test in 2013, a decline from 38 in 2010 and even bigger drop from the 41 percent who had them in 2008. Diagnoses also were declined, dropping from 213,000 in 2011 to 180,000 in 2012.

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The second study, published in the same journal, conducted by researchers at Brigham and Women's Hospital, Dana-Farber Cancer Institute, and the Henry Ford Health System, also found large declines in screening: 45 percent of men between the ages of 60 and 64 got a PSA test in 2010, with 35 percent getting them in 2013; and 23 percent of men between the ages of 50 and 54 had them in 2010, but 18 percent got them in 2013.

While the researchers acknowledge overtreatment is detrimental for patients, the chances of catching prostate cancer before it becomes a significant problem drops with less screening. Penson wrote he wouldn't be surprised to an increase in cancer mortality as fewer men have PSA tests.

"This study raises a troubling suggestion that we may be missing patients we want to find with screening," Dr. Richard Greenberg, chief of urologic oncology at Fox Chase Cancer Center, told HealthDay. "Specifically, younger men who are currently not getting screened may have cancer 10 years from now that is no longer curable," Greenberg said.

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