RAO Davao City

United States Military Retiree Activities Office Davao City, Philippines

PROSTATE PROBLEMS UPDATE August 15, 2006

Posted by Service Officer on August 14th, 2008

In a move that could lead to significant changes in medical care for older men, a national task force in the United States recommended that doctors stop screening men ages 75 and older for prostate cancer because the search for the disease in this group is causing more harm than good. The new guidelines, issued 4 AUG by the U.S. Preventive Services Task Force, represent an abrupt policy change by an influential panel that had withheld any advice regarding screening for prostate cancer, citing a lack of reliable evidence.

Though the task force still has not taken a stand on the value of screening in younger men, the shift is certain to re-ignite the debate about the appropriateness of prostate cancer screening at any age. Screening for prostate cancer is typically performed with a blood test measuring prostate-specific antigen, or PSA, levels. Because it is not clear precisely what PSA level signals the presence of cancer, many men experience stressful false alarms that lead to unnecessary surgical biopsies to make a definitive diagnosis, which can be painful and in rare cases can cause serious complications. Widespread PSA testing has led to high rates of prostate cancer detection. Last year, more than 218,000 men in the United States were found to have the disease. About 28,000 die of it, making it the most common cancer and second-leading cancer killer among men.

Various studies suggest the disease is “over-diagnosed” – that is, detected at a point when the disease probably would not affect life expectancy – in 29 to 44% of cases. Prostate cancer often progresses very slowly, and a large number of these cancers discovered through screening probably will never cause symptoms during the patient’s lifetime, particularly if that patient is older. At the same time, aggressive treatment of prostate cancer can greatly reduce a patient’s quality of life, resulting in complications like impotence and incontinence. Past task force guidelines noted that there was no benefit to prostate cancer screening in men with less than 10 years left to live. Since it can be difficult to assess life expectancy, it was an informal recommendation that had limited impact on screening practices. The new guidelines take a more definitive stand; however, stating that the age of 75 is clearly the point at which screening is no longer appropriate. The task force was created by Congress to analyze current medical research and to make recommendations about preventive care for healthy people. Its guidelines are viewed as highly credible and often are relied on by practicing physicians in making decisions about patient care. It is estimated that one out of every three American men 75 and older is now screened for prostate cancer. [Source: International Herald tribune Tara Parker-Pope article 5 Aug 08 ++]

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