Unfortunately, you can run into trouble when looking for trouble -- and then trouble is just what you find.
That, in essence, is the conclusion of the prestigious United States Preventive Services Task Force with regard to prostate cancer screening in men age 75 and older. The group's review of the scientific evidence, just published in the Annals of Internal Medicine, led them to conclude that screening for prostate cancer in this group does more harm than good.
Why? Prostate cancer is quite common in men in their 70s and 80s, but often the disease is indolent. Most men who die over age 80 die WITH prostate cancer, but not of it. So when prostate cancer is found through screening in older men, the treatment is apt to be worse than the disease. Treating a disease that would do no harm if left alone is not the goal of screening.
Perhaps the tougher pill to swallow is that the Task Force does not specifically recommend prostate cancer screening for anyone! They conclude that the evidence related to screening in younger men is equivocal: there is a fairly even trade-off between the potential benefits of finding and treating aggressive cancer early, and the potential harms of unnecessary therapy. We are not yet very good at distinguishing between those prostate cancers that warrant treatment to prevent progression, and those that do not.
The Task Force does not recommend against prostate cancer screening, either. They conclude that the scientific evidence does not allow for a conclusion -- so they pass the buck. The recommend that doctors and patients discuss the matter, and choose a personally tailored approach. This does make sense; when the case for medical action is not driven by strong science, it should be driven strongly by patient preference.
For whatever it's worth, I am technically now 5 years into my candidacy for prostate cancer screening, and I have chosen to opt out. But I also choose to take very good care of myself, and minimize my risk of getting prostate cancer in the first place.
Looking for trouble should be a way of fixing it, not causing it. Screening for cancer is among the more important, and all too often underutilized, activities of Preventive Medicine. But not all cancer screening is created equal. Mammography, colonoscopy, Pap smears are all strongly recommended. But in other cases, such as prostate cancer, just because we know how to look for trouble -- doesn't necessarily mean we should.
More ways to prevent prostate cancer:
Have sex 5 times a week -- seriously?
