quality of life or longevity,” Donovan shares. “All men with low-risk and many with moderate-risk prostate cancer could safely choose surveillance over surgery or radiation.”
The risks and benefits of screening
The new study adds more fuel to the ongoing controversy over the benefits and risks of prostate cancer screening.
Prostate cancer rates in the United States rose by three percent a year between 2014 and 2019 after two decades of decline, and advanced prostate cancers increased by about five percent a year, the latest American Cancer Society statistics show.
As a result, some experts are rethinking guidelines that currently leave prostate cancer screening a personal choice between a man and his doctor.
The American Cancer Society (ACS) is reevaluating its own guidelines, which recommend that doctors discuss screening at age 40 for men with a close relative who’s had prostate cancer, at 45 for men at high risk of prostate cancer, and at 50 for nearly all other men, ACS Chief Scientific Officer Dr. William Dahut says.
“I actually think having the PSA value does make it much easier to have shared decision-making,” Dahut adds. “If the PSA value is very high, that puts you forward to maybe consider an MRI and then a biopsy. If it’s very low, don’t do anything about it. If it’s in the middle, then we watch it for a while. But not having that number, I do think it makes it much more difficult to really give good advice.”
However, Donovan says these new results seem to indicate that more prostate cancer screening will only lead to unnecessary medical procedures.
“Men should carefully consider all the potential consequences of having a PSA test before deciding to have one,” Donovan advises. “A PSA test can be followed by a snowball of further testing, including biopsies of the prostate, and, if there is a cancer, the likelihood is that it would be of localized and low-risk. Then there will be difficult decisions to make about treatment, and a ‘healthy’ man can become a ‘cancer patient’ unnecessarily.”
Dahut did note that nearly twice as many men assigned to active monitoring had their prostate cancer spread into other parts of the body during the 15-year follow up — 51 men (9.4 percent) in the active-surveillance group, compared with 26 (4.7 percent) in the surgery group and 27 (5 percent) in the radiation group.
“The fact that people who could have had treatment and could have potentially never had their cancer come back instead waited until the cancer was metastatic. For me, that’s really quite concerning,” Dahut says.
Other experts take a different view, arguing that the study shows even men with metastases don’t necessarily die from