Experts recommend refusing screening for prostate cancer

An independent expert commission recommends that US doctors do not conduct a special blood test to detect prostate cancer. The advisory group established by Congress believes that a widely used test carries more harm than good.

Prostate cancer is the second most common form of cancer diagnosed in American men. In the past year, 240 thousand people received bad news, mostly elderly people over 60 years old. For 33 thousand people, the disease led to death.

The prostate or prostate gland is a small organ that looks like a walnut. It is part of the reproductive system of the male body and produces a fluid that is part of the sperm.

Since the 1990s, the prostate specific antigen (PSA) test has become an ordinary medical procedure for men over 55 in the US and a number of other developed countries. During this analysis, the protein content in the blood is measured, the level of which increases in the presence of prostate cancer cells. In case of detection of cancer, the patient undergoes intensive treatment aimed at reducing the tumor. This can be radiotherapy, surgery or estrogen administration.

However, often a PSA test gives a false alarm signal, and men who, as it turns out, do not have any cancer or tumors so small that they do not pose a real threat to health, have to undergo unnecessary and potentially dangerous procedures, such as prostate tissue biopsy.

In 2008, the expert commission recommended to abandon PSA tests for men over 75 years old. Now experts believe that these tests are not needed at all. The commission came to this conclusion on the basis of two large studies, which aimed to assess the benefits of such tests.

Based on the results of clinical trials conducted in the US and Europe, experts concluded that the risk of screening the prostate greatly outweighs the benefits from it.

"In the most favorable case, only one person out of a thousand who have undergone this procedure will avoid death from prostate cancer in the next ten years," explains the chairman of the expert commission, Virginia Moyer. - At the same time, two or three people will get complications in the form of a thrombus, heart attack or stroke. And forty people will have serious consequences of the intervention: erectile dysfunction, urinary incontinence or both. "

In addition, five of this thousand will die within a month after the surgery for the treatment of prostate cancer.

But not everyone agrees with the recommendations of experts. Critics say that in the studies on which they are based, there are serious shortcomings. In particular, they say, the wrong methodology challenges the conclusion of a study conducted in the US on 76,000 men, namely that the death rates from prostate cancer among men who have undergone this procedure and do not pass it do not differ.

The commission also relied on research in seven European countries, which concluded that the PSA test helps to save at best only a few lives. However, critics believe that if the errors in the methodology of the study are corrected, it turns out that this test reduces the risk of death from prostate cancer by one third.

Dr. William Catalona is professor of urology at the Faculty of Medicine at Northwestern University in Illinois and head of the Faculty's Prostate Cancer Research Program. According to him, the recommendations of the expert group border on irresponsibility.

"This is absolutely unreasonable, groundless and unproven step," he says. This is a very bad recommendation. "

Catalona says that the PSA test reveals between 10 and 15 percent of men who are at risk for developing prostate cancer. Many men with elevated PSA levels are given a biopsy. Catalona compares it with the use of novocaine in dentistry to relieve pain.

"Yes, it will be uncomfortable. For a while, it will be a little bitter, but after a few days it will all go away, "he says. "And you will be happy about it, because if you did not do it and the abscess began, everything would be much worse."

The commission's chairman, Virginia Moyer, says that experts do not recommend completely abandoning PSA tests. They only believe that there is no need for mass screening.

"If a person insists on carrying out a study and understands its potential benefit and possible harm, then why should he forbid it. This is his individual choice, "she says.

Doctors are not required to follow the recommendations of the commission, but they can be listened to by insurance companies that may refuse to cover the cost of the PSA test. The commission's recommendations and a critical comment by Dr. William Catalonia are published in the journal Annals of Internal Medicine.

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