More doctors say men should think twice about prostate cancer screening

(Reuters Health) – Most men should not undergo routine screening for prostate cancer because the potential benefits are minimal and there are obvious drawbacks, concludes a group of international experts.

Some men, including those with a family history of prostate cancer, are more likely to benefit from testing and should discuss the advantages and disadvantages with their doctor to make an informed decision, recommend medical experts in published guidelines in the BMJ.

"Most, but not all, well-informed men who understand the tradeoffs would choose not to be tested," said co-author Dr Philipp Dahm of the University of Minnesota and Minneapolis Veterans Administration. Medical Center.

"Only men who place more importance on reducing mortality from prostate cancer – men who are most at risk because of a family history or African descent, or simply anxious to exclude a cancer diagnosis." – can opt for for screening, "said Dahm by email. "Shared decision-making is necessary to help them make a decision that is compatible with their own values ​​and preferences."

Most men with prostate cancer are diagnosed with low-risk tumors that do not spread to other parts of the body. Doctors and patients often struggle to choose between active surveillance and treatments such as surgery or radiation because it is difficult to determine which tumors will develop quickly enough to be life threatening and which ones will not. never.

The Prostate Specific Antigen (PSA) blood test is the only widely available test for detecting prostate cancer. It is used in many countries, but remains controversial as it has increased the number of healthy men diagnosed and treated unnecessarily for harmless tumors.

In drafting the guidelines, the experts reviewed research findings from studies of more than 700,000 men. Studies have shown that if screening reduces the number of prostate cancer deaths, the effect is very small.

"PSA screening increases the number of men who require additional diagnostic tests, such as prostate biopsy (approximately 100 per 1000 men screened) and increases the number of men diagnosed with breast cancer. prostate (18 per 1000 men screened) "guidelines Dr. Kari Tikkinen from the University Hospital of Helsinki and the University of Helsinki in Finland.

"However, many of these men would never have had any symptoms of prostate cancer if they were not diagnosed," Tikkinen said by email.

For this reason, it is reasonable for doctors to suggest the possibility of testing with men at increased risk, conclude the guidelines. For most men, who do not have an increased risk, doctors can avoid this conversation.

"Prostate cancer is extremely common in men 70 years and older and most of them will die" with their cancer "rather than developing complications and dying, and small prostate cancers do not cause no symptoms, "co-authored an accompanying editorial and professor at the Oxford University in the United Kingdom

"Therefore, if you have a screening program that diagnoses many of these men with rather slow growth cancers, then you are doing a" good person "in a patient," Neal said by email. "Then, some of these men will be offered radical treatments with radiotherapy and surgery and will develop the complications of treatment, but because their tumors were low risk, they do not benefit from any radical treatment as they do not have to." They never needed it. "

Because most doctors already think this way of screening, the new guidelines are unlikely to change clinical practice, Neal added.

SOURCE: bit.ly/2QUA8p7 BMJ, online September 5, 2018.