http://www.time.com/time/printout/0,881 ... 81,00.html

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(NEW YORK) — Doctors should stop routine prostate cancer screening of men over 75 because there is more evidence of harm than benefit, a federal task force advised Monday in a new blow to a much scrutinized medical test.

The U.S. Preventive Services Task Force, which made the recommendation, reported finding evidence that the benefits of treatment based on routine screening of this age group "are small to none." However, treatment often causes "moderate-to-substantial harms," including erectile dysfunction and bladder control and bowel problems, the task force said.

The new guidance is the first update by the task force on prostate cancer screening since 2002. The last report on the subject from this panel of experts, which sets the nation's primary care standards, concluded there was insufficient evidence to recommend prostate screening for men of all ages.

In recent years, there has been a growing debate about the value of the somewhat imprecise PSA test to detect cancer, as well as the value of treating most prostate cancers. A number of experts contend patients are being overtreated.

Most major U.S. medical groups recommend doctors discuss the potential benefits and known harms of prostate screening with their patients and make individual decisions. And most agree such testing shouldn't occur before age 50.

The federal task force reviewed past research in reaching its conclusion and "could not find adequate proof that early detection leads to fewer men dying of the disease," task force chairman Dr. Ned Calonge of Denver, said in a statement.

Prostate cancer is the most common cancer in American men — about 220,000 cases will be diagnosed this year. It is the second leading cause of cancer deaths in men. But most tumors grow so slowly they never threaten lives. There is no accurate way to tell which tumors will.

Earlier this year, a study found that older men who already had early-stage prostate cancer were not taking a big risk by not treating it right away. The vast majority were alive 10 years later without significantly worrying symptoms or had died of other causes.

Prostate cancer treatments are tough, especially on older men. Some doctors instead recommend "watchful waiting" to monitor signs of the disease and treat only if they worsen, but smaller studies give conflicting views of the safety of that approach.

The new guidelines from the Preventive Services Task Force were published in this month's Annals of Internal Medicine.

I am 65 and I am not certain what I will do at the time someone panics. I will not submit to the most radical therapies.l

Great article thanks paolo

I disagree strongly with the main conclusion of this article -- that men older and younger than an arbitrary age bracket should not have screening for prostate cancer. I say the grounds given for this conclusion are spurious and assume that screening that appears positive for prostate cancer will always result in treatment for it as well -- an absurdity on its face, given that many cases are slow moving and may be outlived.

In effect the article advocates prevention of inappropriate or unnecessary cancer treatment by avoiding knowledge of whether the cancer may exist. That's an ostrich's method of risk avoidance, or a heartless Scrooge's, not an intelligent human's.

My own very necessary prostate cancer treatments at age 64 would have been simpler, less expensive, and have less side effects had I been screened during the six years before 2006 and promptly been treated, before reaching the intermediate stage that prevailed when it was discovered. Had I been 75 instead of 63 when having this stage and seeking screening, but denied screening under this guise of "saving me" from treatment, I'd be beyond saving my life within a few more years of not knowing.

I believe in first screening by PSA test at 30 to get a baseline, then if it's plenty low repeating at four-year intervals. Buy your own PSA testing if necessary. When PSA goes over 2.5, then also test once for "free PSA percentage" and regard 20% and higher as benign. At 4.0 do "free PSA" with each PSA test and do them annually. When they climb higher than that and rapidly, and free PSA falls under 15%, then consider a biopsy to resolve the doubt.

This advice is akin to advising checking the gages and oil presure in your car, in that it can tell you when you need a professional "mechanic" to help you with the treatment question. Not checking your oil because your car is old is not a good way to lengthen its good service to you.

Prostrate Cancer is the price Males pay for the honor and privilege of having testicles.

Medicine is about helping people live a more comfortable life, so the question is how much more comfortable would an 80 year old be after undergoing treatment and surgery then if it was aloud to run its course? Any surgery is a risk (even routine ones) of death and permanent harm. Should an 80 year old male undergo life threatening surgery that will permanently alter his life, or allow the cancer to run its course knowing that as he gets older the odds of death become higher and higher.

would it not make sense to just castrate these older men and then let the cancer alone

I had 4 uncles with prostate cancer in their early 70s

3 were castrated because that is what they wanted..one refused..he considered it a terrible thing..the uncastrated uncle had his prostate removed ..it was back in 3 years..it had spread everywhere..chemo radiation..then a month fefore he died the tried chemical castration.

the other 3 died at 96...92....88 all of other problems.

After long discussions about this with the men in the family..we have come to the agreement that it is best for the males to be castrated if we get prostate cancer..many of us wanted it done as a preventative.

There appears to be a balance between Paolo's and Woggler58's positions. Paolo addresses the national urological's frenzy to engage men at the slightest signs or excuses to commence prostate care: if in most cases to get their daughters though college, to get a Mercedes, and/or to pay off their multi million dollar investment in their own medical equipment whether its necessary or not or whether or not you really qualify for medical attention.

That's why its really important to side step your favorite local Urologists and go to www.nccn.org (National Compreshensive Cancer Network) to locate the closest clinic you can get to and also to teach yourself the basics of prostate cancer treatment which is logical and sensible unlike the local urological hype.

Paolo did a great service in reporting the essence of the newly suggested guidelines and Woggler58's recommendation to "do it yourself" testing supports the keep-safe strategy.

Thank you, John. Paolo indeed has served us in posting that Time article. It's part of the medical conclusions therein that I disputed, and I didn't impute any "position" on them to Paolo.

Not disputed by me is that a host of adverse outcomes can result from inexpert treatment for prostate cancer, so need for treatment at all must be carefully weighed. And then, only a truly expert "artist" at treating should be used. Some unwanted outcomes will temporarily result from even the best treatment, and some others, such as little or no semen production, are inevitable with all forms of treatment that are intended to eliminate the cancer. Difficulty with erections are common.

Having PSA tests for their early warning value does pose the bother of having to cope with a non-negative result. That's the downside of loss of ignorance: loss of bliss. What you lose and when you lose it is what's at stake if you have a prostate that's become cancerous. No testing means no choosing.

IbPervert (imported) wrote: Tue Aug 19, 2008 6:50 pm Prostrate Cancer is the price Males pay for the honor and privilege of having testicles.

Medicine is about helping people live a more comfortable life, so the question is how much more comfortable would an 80 year old be after undergoing treatment and surgery then if it was aloud to run its course? Any surgery is a risk (even routine ones) of death and permanent harm. Should an 80 year old male undergo life threatening surgery that will permanently alter his life, or allow the cancer to run its course knowing that as he gets older the odds of death become higher and higher.

We could make an entire new thread on this subject. When does someone become old enough that treating a disease or performing a surgery could have greater odds of diminishing returns for the patient, and by extension be a waste of money and resources? (You can't separate them in today's medical market.)

You can't make any hard and fast rules. It had to be decided by patiend and procedure. My Dad decided to go ahead with a hip and a shoulder replacement, within 5 weeks of each other, at age 90. (Fortunately, he can afford it.) He survived both surgeries, has recovered nicely, with physical therapy, and is confident that he will live relatively pain free and able to get around until 100. Individual differences!

A doctor friend of mine advised that the standard of care is moving toward a baseline PSA level at 30 years.

chilli-