Men over the age of 75 should no longer be screened for prostate cancer because the potential harm from the test results -- both physical and psychological -- outweighs any potential benefit from treatment, a federal panel said Monday.
Most oncologists already argue against treating most men in that age group for prostate cancer because they are more likely to die from some other cause than from their tumor.
For The Record
Los Angeles Times Wednesday, August 13, 2008 Home Edition Main News Part A Page 2 National Desk 1 inches; 58 words Type of Material: Correction
Prostate cancer: An Aug. 5 article in Section A about new guidelines for prostate cancer screening said the American Cancer Society and the American Urological Assn. recommended a PSA test for men older than 50 if they had a life expectancy of more than 10 years. Both groups recommend only that the test be offered to such men.
The new guidelines go one step further, saying, in effect, why test if the patient is unlikely to be treated?
The guidelines, published in the Annals of Internal Medicine, are only recommendations, but they are relied on by many physicians in determining patient care.
The recommendations could therefore trigger a decline in prostate cancer testing in the elderly.
The recommendations provoked a backlash from some experts.
"It sounds like a regulation promulgated by an HMO" to save money, said Dr. Dudley Danoff, president of Tower Urology in Los Angeles.
"I don't think it is fair to a guy who is 75. Yesterday's 75 is not the 75 of the 1950s. . . . If you stop screening and treating men at 75, you are going to have a lot more people dying of prostate cancer."
Dr. David Penson, associate professor of urology at USC's Keck School of Medicine, called the recommendation "a form of ageism."
"You can't make cookie- cutter recommendations," Penson said, adding that the advice could hurt patients by prompting insurance companies to stop paying for the cancer test, which costs $40 to $60.
Prostate cancer is the most common type of cancer among men after skin cancer. The American Cancer Society estimates that 186,320 new cases of prostate cancer will be diagnosed in the U.S. in 2008 and that 28,660 men will die of the disease this year.
There is controversy about whether to treat prostate cancer, because the tumors can take two forms: a fast-growing, aggressive one or a slowly progressing one that is relatively benign.
Most elderly men have the slow-growing form.
"The problem is that we can't tell which ones are really bad," said Danoff, who had not seen the new guidelines.
The test in question is called the prostate-specific antigen or PSA test, which most men start receiving at the age of 50.
High blood levels of the antigen in the test generally indicate the presence of a tumor. But confirming it requires a biopsy.
