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5 August 2008
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Men over 75 years 'should not undergo prostate cancer screening'
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MedWire News: Men aged 75 years and older should not undergo prostate cancer screening, and younger men should discuss the benefits and drawbacks of the prostate-specific antigen test with their doctors before undergoing screening, US experts recommend.
The recommendations are made by the US Preventive Services Task Force following a review of published studies conducted by Dr Kenneth Lin, from the Agency for Healthcare Research and Quality in Rockville, Maryland, and colleagues.
The prostate-specific antigen test was approved by the US Food and Drug Administration in 1986, and its use for prostate cancer screening has increased significantly among men of all ages since the mid-1990s.
However, high prostate-specific antigen levels can also indicate the presence of non-cancerous conditions of the prostate, as well as prostate cancer, says the team.
Furthermore, potential drawbacks associated with prostate screening include additional medical visits, adverse effects of prostate biopsies, anxiety, and overdiagnosis - the identification of prostate cancer that would never have caused symptoms in the patient's lifetime, leading to unnecessary treatment, anxiety and other negative psychological effects.
After examining the evidence, the US Preventive Services Task Force says that as men aged 75 years have an average life expectancy of around 10 years, the negative effects of prostate cancer screening outweigh the positive effects.
For the same reasons, men younger than 75 years with long-term medical problems and a life expectancy of less than 10 years are also unlikely to benefit from screening.
Furthermore, the Task Force recommends that all men younger than 75 years should be educated about the risks and benefits associated with screening before undergoing the prostate-specific antigen test.
"Because many prostate cancers grow slowly, early detection may not benefit a patient's health and in some cases may even cause harm," said Task Force Chair Dr Ned Calonge, chief medical officer for the Colorado Department of Public Health and Environment in Denver.
He added: "We encourage men younger than 75 to discuss with their clinicians the potential, but uncertain, benefits and the possible harms of getting the prostate-specific antigen before they decide to be screened."
The recommendations and research are published in the Annals of Internal Medicine.
Ann Intern Med 2008; 149: 185-191, 192-199
http://www.annals.org/cgi/content/abstract/149/3/185
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