Is mass prostate cancer screening even ethical in men ≥ 65 years of age?


Now here’s a new perspective on the value of widespread prostate cancer screening from one of the founders of Prostate Cancer Awareness Week — Dr. David Crawford of the University of Colorado Health Science Center in Denver, CO  (who is also the Chairman of the Prostate Conditions Education Council):

The utility of screening and diagnosing prostate cancer clearly deteriorates with increasing age. In a population over age 65, approximately 200 men need to be treated for at least 12 years before 1 prostate cancer death is prevented.

This quote is taken from an article by Spendlove and Crawford in the December issue of The ASCO Post (referencing an earlier article by Wong et al.).

If this statement is correct, then the idea that we should be screening men of ≥ 65 years of age for risk of prostate cancer would appear to be, at best, dubious.

As regular readers will be aware, The “New” Prostate Cancer InfoLink has long questioned the value of mass, population-based screening for prostate cancer (as contrasted with thoughtful, individual, risk-based testing). The consequences of treating 200 men for 12 years (2,400 life-years of treatment) to actually “save” a single life implies massive unnecessary risk for complications of treatment among 199 men who are going to receive no benefit from such treatment … and of course we have no good way to tell which of the 200 men so treated are likely to benefit. Is this even ethical?

We would note that, in the early and mid 1990s, Dr. Crawford was among the strongest of advocates for mass screening with the PSA test. The quotation above would appear to imply that he has had a significant change of heart. Perhaps this really does signal the beginnings of a sea-change within the urology community.

2 Responses

  1. I recognize the technical distinction between mass screening and individual screening. What worries me is that men over 65 will use this as an excuse to skip getting tested at all. My brother was diagnosed with metastatic prostate cancer at age 71 and died four years later. In 2004, at age 74, I was diagnosed with highly aggressive prostate cancer, which fortunately was caught before it spread. I was treated (external radiation) and there is no sign of recurrence to date.

  2. Manny:

    Your concern is completely understandable.

    Obviously I don’t know whether either you or your brother had been getting PSA tests before you both got diagnosed (at 74 and 71 years, respectively). I therefore have no idea whether either of you would have met criteria for risk-based testing on a regular basis. This approach is going to be critical to how we move forward because it is becoming increasingly clear that many men do not need or benefit from regular, annual testing … but some others very defininitely do, and we need to be able to sort the wood from the cancer (so to speak).

    In an ideal world, we should be able to identify men like yourself and your brother as being “high risk” for future metastaic disease early, monitor you carefully until curative therapy is clearly needed, and then give you that curative therapy … thus maximizing your quality of life until therapy was necessary and optimizing the quantity of life once avoidance of clinically significant prostate cancer becomes the priority.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Follow

Get every new post delivered to your Inbox.

Join 1,169 other followers