Posted: September 9, 2017

Should men be screened for prostate cancer?  Does the good outweigh the harm?  In 2012 the US Preventive Services Task Force opined that routine prostate cancer screening with the PSA test for men over 50 be eliminated, in the absence of compelling outcomes data.  They suggested that doctors and their patients have a discussion about risks and benefits of screening; this recommendation was viewed as a cop-out by many working in the field.  Into the fray now comes a study published in Annals of Internal Medicine in September, 2017, in which the authors take another look at the issue.  Click here for the abstract.  If you wish the entire article send Dr. Stark a message on the form to the right of this screen.  For copyright reasons he cannot post the entire article on this website.  The authors looked at two large studies completed in the last five years that came to divergent conclusions about the merits of screening, the ERSPC European trial, which found a modest benefit to screening, and the PLCO American trial, which found none.  Based on careful statistical analysis they concluded that both trials show that earlier diagnosis does convey a slight survival advantage.  It was the difference in the structure of the trials that yielded conflicting results, not a difference in biology or other factors.  The authors conclude that prostate cancer screening does save lives. Striking is that the difference between screening and no screening produced a very small, albeit significant improvement in outcome.   In an accompanying editorial Dr. Andrew Vickers from Memorial Sloan Kettering Cancer Center in New York agreed with the findings and reframed the discussion: in light of the morbidity from prostate cancer treatment, how much disability are we as a society willing to inflict on large numbers of men to save a relative few from early death?

Dr. Stark weighs in: “As a man who started prostate screening at 50, then gave it up at 67 when the USPSTF changed its stance, then resumed it again recently, I feel the collective pain of men over 50 who don’t know what to do.  We need better markers to determine who with newly diagnosed prostate cancer needs treatment, who doesn’t and who has a version of the cancer that is so aggressive that he wll die no matter what is done.  We are probably only a few years away from knowing this, but don’t know it yet.”