Prostate Cancer Screenings: The Debate Continues

Researchers who set off a firestorm in 2009 when they questioned the need for all adult men to undergo annual prostate cancer screenings have updated their findings.

Remember back in 2009 when a team of researchers from Washington University School of Medicine in St. Louis, Missouri, suggested annual prostate cancer screenings shouldn’t be based solely on age? At the time, oncologists and high-profile survivors, including Joe Torre and Rudy Giuliani, quickly unleashed their disapproval.

Upon that study’s release, the researchers acknowledged that few participants in their Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) (http://www.nejm.org/doi/full/10.1056/NEJMoa0810696#t=article) died at all, making it unrealistic to broadly recommend against annual prostate cancer screenings. However, at the time, they did suggest the screenings were unnecessary for elderly men and those with a life expectancy of less than 10 years.

Two years later, after expanding the scope of their research, the authors have released updated findings: Annual screenings lead to more diagnoses but don’t save more lives. They are now advising that annual prostate cancer screenings be reserved for young, healthy adult males and those at high risk, such as African-Americans, or with a family history of the disease. Read an excerpt here: (http://jnci.oxfordjournals.org/content/104/1/8.extract).

The updated findings appear to suggest that one of the pillars of managed care—preventive care—isn’t universally useful. But here’s the researchers’ stance: Yearly prostate cancer screenings based strictly on age may lead to unnecessary surgeries and radiation therapy, paving the way for possible complications or side effects, which in turn potentially reduces quality of care and raises costs.

When the 2009 study was released, Dr. Isaac Yi Kim, Chief, Section of Urologic Oncology, The Cancer Institute of New Jersey, and Executive Director, Gallo Prostate Cancer Center, The Cancer Institute of New Jersey, vocalized his concern about the initial recommendations.

Today, Dr. Kim maintains his original position. In the following statement, he compares the PLCO study with one done overseas—both known to represent the “gold standard.”

“…The PLCO study carried out in the US with more than 76,000 patients demonstrated no benefit with screening, while the other trial with more than 182,000 men was completed in Europe and demonstrated a 20% reduction in prostate cancer mortality. Of these 2 studies, the PLCO trial was significantly flawed in that the compliance rate for prostate cancer screening in the ‘screened’ group was only 85%, while more than 40% of the patients in the ‘unscreened’ group were screened at least once during the study period. The precise number of patients in the European study who received screening in the ‘unscreened’ group is not clear,” Dr. Kim said. “Nevertheless, because PSA screening is a common practice, it is likely that the rate of contamination is also likely significant in the European study. A more telling statistic is that the rate of prostate cancer deaths since the introduction of PSA has decreased by 40%. Taken together, these results suggest that the current medical practice has significantly lowered prostate cancer mortality and that no men should stop prostate cancer screening.”

The researchers plan to re-evaluate the PLCO participants further down the line. The debate continues.