Originally published October 15 2009
Men not being informed about low benefits and high risks of PSA prostate cancer screening
by S. L. Baker, features writer
(NaturalNews) Regular readers of NaturalNews know that recent studies have found little if any benefit to prostate cancer screening tests (http://www.naturalnews.com/026787_cancer_Pro...). What's more, although about one in six men will be diagnosed with the disease during their lifetime, only one in 35 will actually die from prostate cancer -- and the latest research shows that a diagnosis of the disease does not automatically mean any treatment is needed at all (http://www.naturalnews.com/025859_cancer_Pro...). Unfortunately, most men don't know these facts and are not being told about the risks of prostate-specific antigen (PSA) screening. The result? Many are being pushed into having PSA tests, leading to unnecessary and side effect laden treatments.
A report just published in the September 28 issue of Archives of Internal Medicine concludes the majority of men just don't know the basic facts about PSA testing. They are making decisions about prostate cancer screening based on conversations with their doctors -- and these talks usually don't include information about risks versus benefits of the test. Although most American men 50 or older have been screened with a PSA test, the new report reiterates the fact there's no convincing scientific evidence that screening prevents deaths from prostate cancer. And if men are found through PSA screenings to have early-stage cancers, they are often told treatment is necessary when, in fact, it may not be and may lead to a host of health problems and complications.
"Given the uncertain benefit for screening and known treatment risks, prostate cancer screening decisions should be guided by patient preferences," the authors wrote. "Indeed, most professional organizations recommend that the first step in screening should be a discussion between health care providers and patients about the risks and benefits of early detection and treatment so that patients can make informed decisions about whether to be screened."
No real benefit to PSA screeningRichard M. Hoffman, M.D., of the New Mexico VA Health Care System and the University of New Mexico School of Medicine in Albuquerque, and his research team surveyed 3,010 randomly selected English-speaking adults age 40 and older in 2006 and 2007 by phone. Out of these, the scientists found 375 men who had either undergone or discussed PSA testing with their physicians in the previous two years. The researchers asked the men what their knowledge was concerning prostate cancer, what their talks with their doctors covered, and what factors and information helped them decide to be screened for a prostate malignancy.
The results showed that almost 70 percent of the men had discussed screening with their doctors before making a decision to have the PSA test. Out of these, only 14.4 percent turned down the screening. In the vast majority of cases, almost 65 percent of the time, it was the doctors who brought up the supposed need for PSA tests. In fact, 73.4 percent of physicians recommended the test and this recommendation from a doctor was the only part of the discussion about prostate cancer that was linked to testing.
According to a statement to the media, the researchers said only 47.8 percent of men surveyed could correctly answer any of three basic questions about prostate cancer risk and screening accuracy. "Although respondents generally endorsed shared decision-making process and felt informed, only 69.9 percent actually discussed screening before making a testing decision, few subjects (32 percent) reported having discussed the cons of screening, 45.2 percent said they were not asked for their preference about PSA testing and performance on knowledge testing was poor," the study authors wrote. "Therefore, these discussions -- when held -- did not meet criteria for shared decision making. Our findings suggest that patients need a greater level of involvement in screening discussions and to be better informed about prostate cancer screening issues."
In another study also published in the same edition of Archives of Internal Medicine, Kirsten Howard, Ph.D., of the University of Sydney, Australia, and colleagues constructed a statistical model to predict the benefits and harm of annual PSA screenings. They found yet again that screened men are two to four times more likely to be diagnosed with prostate cancer than unscreened men -- but death rates from prostate cancer and from all causes are not significantly different. Bottom line: the researchers conclude that many men with prostate cancers detected by PSA screening are most likely undergoing treatment for clinically insignificant cancers that pose little if any threat to their lives.
"In conclusion, before undergoing PSA screening, men should be aware of the possible benefits and harms and of their chances of these benefits and harms occurring," they wrote. "Even under optimistic assumptions, the net mortality benefit is small, even when prostate cancer deaths are cumulated to 85 years of age. These quantitative estimates can be used to support the goal of individual informed choices about PSA screening."
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