Study: PSA Screening Caused 1 Million Unnecessary Prostate Cancer Diagnoses

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By Denise MannMONDAY, August 31, 2009 (Health.com) — More than 1 million American men may have been unnecessarily diagnosed and treated for prostate cancer since widespread use of the prostate-specific antigen (PSA) blood test began in 1987, a new study says.

“All overdiagnosed patients are needlessly exposed to the hassle factors of obtaining treatment, the financial implications of the diagnosis, and the anxieties associated with becoming a cancer patient,” concluded the researchers, who were led by H. Gilbert Welch, MD, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, in Hanover, N.H. The study was published online in the August 31 issue of the Journal of the National Cancer Institute.

The researchers acknowledge that prostate cancer screenings can indeed save lives; however, their study was conducted to highlight the majority of men who did not benefit from the test.

Screening benefits are questionablePSA is a protein produced by cells of the prostate gland. The higher a man’s PSA level, the more likely it is that he has prostate cancer. However, there are other reasons for a high PSA level.

Also, PSA tests can detect small prostate cancers, including some very slow-growing tumors that are unlikely to be life-threatening and may not add any relevant information about aggressive prostate tumors that are already spreading.

For these reasons, PSA testing is considered controversial because it is not known whether the test actually saves lives or simply leads to unnecessary stress and potentially harmful treatment.

Two recent studies in the New England Journal of Medicine have added to the debate. European researchers found that PSA testing decreases prostate cancer death by 20%, but a U.S. study found no such effect.

For 1 life saved, more than 20 overdiagnosedIn the new study, the researchers examined age-specific prostate cancer incidence and treatment data to figure out the effect of PSA screening on the diagnosis and treatment of prostate cancer.

Overall, 1.3 million men were diagnosed with prostate cancer that wouldn’t have been discovered without the PSA initiative, and more than 1 million of these men were treated between 1986 and 2005.

Assuming that the decline in prostate cancer deaths over this time could be attributed to these screenings, the researchers estimated that for every one man who avoids a death, more than 20 men—and as many as 50—had to be overdiagnosed and treated needlessly.

“[Of those] maybe one-third will have treatment problems such as impotence or incontinence,” says Dr. Welch. Treatments for prostate cancer, including the surgical removal of the prostate gland, can result in such conditions, or even death.

Younger men are at greater riskThe increased diagnosis was most pronounced in younger men, the study showed. Since 1986, prostate cancer diagnoses among men in their 50s had tripled, and there had been a sevenfold increase in diagnoses in men in their 40s.

“I was surprised by how much growth there has been in younger men,” says Dr. Welch. “We are taking what was an old man’s disease and turning it into a young man’s disease. And some of the treatment side effects such as impotence and incontinence are even bigger problems when they start occurring in younger men.”

Differentiating slow- vs. fast-growing cancersChristopher J. Logothetis, MD, a professor and chairman of the Department of Genitourinary Medical Oncology at the University of Texas M.D. Anderson Cancer Center, in Houston, agrees that doctors “are overdiagnosing and overtreating prostate cancer in the PSA screening era.”

The real issue is not the PSA test per se, but how best to apply its results, he says.

“We need to develop a strategy by which we take the good things from screening and protect from the bad things,” Dr. Logothetis says. “Don’t throw the baby out with the bathwater.”

If a PSA test result and a subsequent biopsy do indicate cancer, “we need to know if it is a cancer that possesses the potential to be lethal,” he says. Some prostate tumors are slow-growing and do not need treatment.

“Screening needs to be continued, but patients need to be informed that not all prostate cancers require an intervention,” Dr. Logothetis explains. “A high PSA doesn’t mean you have cancer, and if you do, it does not [necessarily] mean it needs treatment.”

Otis W. Brawley, MD, the chief medical officer at the American Cancer Society, echoed these thoughts in an editorial accompanying the study.

“We desperately need the ability to predict which patient has a localized cancer that is going to metastasize and cause suffering and death and which patient has a cancer that is destined to stay in the patient’s prostate for the remainder of his life,” he wrote.

As it stands, there is no clear consensus on prostate cancer screening from the major medical organizations.

The American Cancer Society does not support routine testing for prostate cancer. The group states that doctors and patients should weigh the potential benefits and risks. By contrast, the American Urological Association urges baseline PSA blood testing for all men starting at age 40.

“There is no correct answer,” says Dr. Welch. “You are not crazy to get screened and you are not crazy not to.”

Saw Palmetto No Better Than Placebo for Prostate Problems

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By Anne Harding

TUESDAY, September 27, 2011 (Health.com) — The millions of middle-aged men who take saw-palmetto supplements to cope with the symptoms of an enlarged prostate might as well be popping sugar pills.

That’s the conclusion of a new clinical trial, published this week in the Journal of the American Medical Association, that found that the herbal extract is no better than placebo at reducing bathroom trips or otherwise improving the urinary-tract symptoms associated with prostate enlargement.

“There’s probably no real benefit,” says Simon J. Hall, MD, the chairman of the urology department at the Mount Sinai School of Medicine, in New York City, who wasn’t involved in the new research. “Ultimately, the way I would look at it is: Is it worth spending $20 or $30 a month to take something that is probably not going to do anything?”

Nearly all men experience some prostate-gland growth as they age. Most have no obvious symptoms, but because the prostate surrounds the urethra, this otherwise harmless enlargement (known as benign prostatic hyperplasia) sometimes causes symptoms such as dribbling after urination, a weak urine stream, and the frequent need to wake up at night to urinate.

Related links:

14 Must-Know Facts About Male Incontinence

Bladder Training Tips to Reduce Bathroom Trips

12 Myths and Facts About Incontinence

Saw palmetto has long been marketed as a remedy for these symptoms, but in clinical trials it has consistently failed to outperform placebo. A 2009 review of 30 randomized controlled trials—including a rigorous 2006 study published in the New England Journal of Medicine—concluded that the herbal extract was no more effective than placebo.

In the new study, the largest of its kind to date, the researchers randomly assigned 369 U.S. and Canadian men with prostate-related symptoms to take saw-palmetto capsules or an identical placebo. After 18 months, the men taking saw palmetto were doing no better than those on placebo, even though the dosage of saw palmetto was increased twice during the study, to 960 milligrams—three times the typical daily dose.

Neither saw palmetto nor placebo made a substantial dent in the men’s symptoms. At the beginning of the study, the average severity of the men’s symptoms measured about 14.5 on a 35-point scale commonly used by urologists; by the end, the average severity had declined by three points in the placebo group and just two points in the saw palmetto group.

Lead author Michael J. Barry, MD, a primary care physician at Massachusetts General Hospital, in Boston, points out that between 40% and 45% of the men in both groups saw a “perceptible improvement” in their symptoms, however. That improvement can be chalked up only to the placebo effect, not to any active ingredients in the saw-palmetto extract. But that doesn’t necessarily mean that men shouldn’t take saw palmetto, Dr. Barry says.

“We can’t show, on the one hand, that it’s better than placebo, but some men do have an improvement in their symptoms, and there seem to be virtually no side effects,” he says. “I wouldn’t object, given the no side effects, if men wanted to try it.”

Next page: $19 million in sales in 2010

Dr. Hall says he doesn’t discourage his patients from taking saw palmetto if the placebo effect appears to be working. “Certainly I’ve had patients tell me…’I’m taking saw palmetto and it’s great,’ and I tell them to keep taking it,” he says.

Saw palmetto, with just under $19 million in sales, was the second bestselling herbal supplement in the United States in 2010 (behind cranberry), according to the SymphonyIRI Group, a Chicago-based market-research firm.

Dr. Barry and his colleagues used a proprietary brand of saw palmetto manufactured in Germany. Since other studies using different brands have had similarly disappointing results, it’s unlikely that one brand is more effective than another, he says.

The study was funded and partially overseen by the National Institutes of Health, although the supplement manufacturer provided all of the saw palmetto and placebo capsules.

Other treatment options for prostate-enlargement symptoms include prescription drugs and surgery. In most cases, Dr. Hall says, treatment is actually not necessary unless there’s a true medical problem—if a man is not able to completely empty his bladder, for example, or if he experiences recurrent bladder infections.

Unnecessary Prostate Cancer Screening Remains Common

By Amanda Gardner

TUESDAY, April 24, 2012 (Health.com) — When billionaire investor Warren Buffett revealed last week that he has been diagnosed with early-stage prostate cancer, the reaction—including from Buffett himself—amounted to a collective shrug.

Buffett said his doctors told him the cancer is “not remotely life-threatening or even debilitating in any meaningful way,” which led some observers to wonder why the 81-year-old had bothered to get screened for the disease in the first place.

Since 2008, an independent panel of experts that advises the federal government on preventive care has discouraged the use of prostate-specific antigen (PSA) tests—a type of blood test—to screen for cancer in men ages 75 and up. Tumors in this population tend to be slow-growing and asymptomatic, so early detection may carry more risks than benefits, the panel concluded.

Buffett’s diagnosis isn’t the only sign that this recommendation hasn’t sunk in. According to a research letter published this week in the Journal of the American Medical Association, PSA testing rates in men over age 75 have remained steady since the panel released its guidelines in 2008.

National survey data shows that 43% of men in that age bracket underwent PSA screening in 2005. In 2010, the researchers found, 44% reported having a PSA test done—a statistically negligible difference.

Related links:

What Men Must Know About PSA Tests

Do You Really Need That Medical Test?

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“Screening patterns couldn’t have been more similar before and after,” says lead researcher Scott E. Eggener, M.D., an assistant professor of surgery at the University of Chicago Medical Center.

PSA tests aren’t harmful in and of themselves, but studies have shown that positive results can lead to psychological distress, unnecessary biopsies, and overtreatment.

In older men, most early-stage tumors don’t require treatment because the men are likely to succumb to something else before the tumor becomes dangerous. Treatments, including surgery and radiation, may be riskier than continuing to monitor a tumor, since they carry a risk of incontinence and sexual dysfunction. (Buffet, for his part, has elected to undergo radiation.)

So why haven’t screening rates budged? The researchers can only speculate, but it could be that doctors and patients simply aren’t aware of the new guidelines. Another, more troubling possibility is that some prostate cancer specialists are recommending PSA tests to collect the reimbursement fee and generate business.

Eggener says neither of these scenarios is especially likely, however. The media coverage surrounding the 2008 guidelines has been hard to miss, he says, and although there may be a “subset” of specialists who are “consciously or unconsciously” overscreening and overtreating their patients, most PSA tests are ordered by primary care physicians with no financial stake in a diagnosis.

What’s more likely is that doctors and patients are accustomed to viewing screening as a good thing, and are unable or unwilling to let that belief go despite all the data to the contrary. “Physicians and patients latch onto the concept of screening for cancer and catching cancers early,” Eggener says.

The ongoing discussion surrounding the appropriate amount of cancer screening extends beyond prostate cancer. The panel that issued the 2008 guidelines, the U.S. Preventive Services Task Force (USPSTF), has spurred controversy in recent years by relaxing its screening recommendations for breast and cervical cancer as well.

In 2011, the task force released draft guidelines that extended its recommendation against PSA testing to men of all ages. The current trend suggests the new guidelines may go unheeded, especially since not everyone agrees that PSA tests should be universally discouraged.

Even among men in the 75-and-over bracket, Eggener says, screening might make sense for certain patients. Older men in relatively poor health probably won’t benefit from early detection and treatment, he says, but that might not be true for a healthy and active 75-year-old who’s likely to live long enough for a tumor to spread.

“It’s very reasonable to check PSA levels, because it might save that guy’s life,” he says.

Men Who Exercise May Boost Their Odds of Surviving Prostate Cancer

MONDAY, April 18, 2016 (HealthDay News) — Sticking to a moderate or intense exercise regimen may improve a man’s odds of surviving prostate cancer, a new study suggests.

The American Cancer Society study included more than 10,000 men, aged 50 to 93, who were diagnosed between 1992 and 2011 with localized prostate cancer—meaning it had not spread beyond the gland. The men provided researchers with information about their physical activity before and after their diagnosis.

Men with the highest levels of exercise before their diagnosis were 30 percent less likely to die of their prostate cancer than those who exercised the least, according to a team led by Ying Wang, senior epidemiologist at the cancer society’s epidemiology research program.

More exercise seemed to confer an even bigger benefit: Men with the highest levels of exercise after diagnosis were 34 percent less likely to die of prostate cancer than those who did the least exercise, the study found.

The findings were to be presented Monday at the annual meeting of the American Association for Cancer Research, in New Orleans.

While the study couldn’t prove cause-and-effect, “our results support evidence that prostate cancer survivors should adhere to physical activity guidelines, and suggest that physicians should consider promoting a physically active lifestyle to their prostate cancer patients,” Wang said in an AACR news release.

The researchers also examined the effects of walking as the only form of exercise. They found that walking for four to six hours a week before diagnosis was also associated with a one-third lower risk of death from prostate cancer. But timing was key, since walking after a diagnosis was not associated with a statistically significant lower risk of death, the study authors said.

“The American Cancer Society recommends adults engage in a minimum of 150 minutes of moderate or 75 minutes of vigorous physical activity per week,” Wang said, and “these results indicate that following these guidelines might be associated with better prognosis.”

Two experts in prostate cancer care said the findings shouldn’t come as a big surprise.

“Physical activity helps all aspects of health,” said Dr. Elizabeth Kavaler, a urology specialist at Lenox Hill Hospital in New York City. “This study reinforces that a healthy lifestyle, including exercise, is one of the few aspects of post-cancer outcome that a patient can control.”

Dr. Manish Vira, of Northwell Health’s Smith Institute for Urology, in New Hyde Park, N.Y., agreed.

The study “adds to the growing body of evidence that regular exercise is associated with better prostate cancer outcomes,” he said. “Multiple studies have shown improvements in other cancers as well, including breast, colon and lung cancer.”

“Regular exercise improves patients’ cardiovascular health, quality of life, and likely, their overall ability to fight disease,” Vira added.

Wang stressed that further research is needed to see if the findings might differ by patient age at diagnosis, weight or smoking.

More information

The U.S. National Cancer Institute has more about prostate cancer.


Fewer U.S. Men Diagnosed With Early Prostate Cancer, But the Trend May Have a Downside

THURSDAY, Aug. 18, 2016 (HealthDay News) — Diagnoses of early prostate cancer continue to decline in the United States, following the U.S. Preventive Services Task Force recommendation against routine screening for the disease, researchers report.

The screening involves a blood test that identifies levels of PSA (prostate specific antigen), a protein produced by the prostate gland. That test can determine when cancer exists, but it often wrongly identifies nonexistent cancer.

These “false positive” results can cause anxiety and lead to unnecessary follow-up tests. Because of this, the task force issued a draft recommendation against routine screening in 2011 and a final guideline in 2012.

Since then, diagnoses of early prostate cancer in American men aged 50 and older dropped by 19 percent between 2011 and 2012 and by another 6 percent the following year, said lead researcher Dr. Ahmedin Jemal. He is vice president of the American Cancer Society’s surveillance and health services research program.

But while many men may have been spared unnecessary anguish, less frequent screening may have a downside. Some experts worry more men will develop potentially fatal prostate cancer as a result.

“Prostate cancer is a slow-growing tumor, so it takes time. We may see it over the next three to five years,” Jemal said.

There is a balance in the task force recommendation, said Dr. Anthony D’Amico, chief of genitourinary radiation oncology at Brigham and Women’s Hospital and the Dana Farber Cancer Institute, in Boston.

“Some men who should not be treated are not being diagnosed, but that also means some men who should be treated are either losing the chance for cure or presenting later and needing to undergo more treatment and more side effects for a possible cure,” he said.

“The answer to this dilemma will come with personalized medicine based on risk-based screening—screening men preferentially in good health and at high risk,” D’Amico added.

The decrease in diagnoses of early-stage prostate cancer may be partly due to a misreading of the task force’s recommendation, added Dr. Otis Brawley, the cancer society’s chief medical officer.

“I believe the task force guideline is being misunderstood,” he said.

“The key word that is missed is ‘routine’—the task force does not recommend routine screening. This in my mind means they are not against all screening. Also, they do call for informed decision-making regarding potential risks and potential benefits,” Brawley said.

Using the Surveillance, Epidemiology and End Results database, Jemal and colleagues looked at cases of prostate cancer diagnosed between 2005 and 2013 in men aged 50 and older.

They found that from 2012 to 2013, early prostate cancer diagnosis rates per 100,000 men dropped from 356.5 to 335 in men aged 50 to 74. In men older than that, early cancer diagnoses fell from 379 to almost 354 per 100,000 men.

Meanwhile, cases of advanced prostate cancer remained stable in both age groups.

The findings leave some room for interpretation. Other factors leading to the decline could include improved preventive measures and changes in the incidence of unknown risk factors, Jemal said.

But D’Amico believes fewer screenings explain the statistics. The drop in the diagnosis of early prostate cancer “is consistent with the drop in PSA screening,” he said.

The main issue is whether this is an early sign that more high-risk disease, more disease that has spread and more deaths from prostate cancer will happen, he added.

“My opinion is that we are probably heading for more high-risk and metastatic [cancer that has spread] disease in the next year or two, followed by more deaths from prostate cancer if the decline in screening is maintained,” D’Amico said.

He added that the only hope for a boost in screening lies with the results of a British trial. If those findings, expected next year, show a benefit for PSA testing, perhaps testing rates will rebound, D’Amico said.

The latest study was published online Aug. 18 in the journal JAMA Oncology.

The American Cancer Society recommends that men “make an informed decision with their health care provider about whether to be screened for prostate cancer.” The decision should be made “after getting information about the uncertainties, risks and potential benefits of prostate cancer screening.” The discussion about screening should take place at:

Age 50 for men at average risk of prostate cancer who are expected to live at least 10 more years.Age 45 for men at high risk of developing prostate cancer. This includes blacks and men who have a first-degree relative (father, brother or son) diagnosed with prostate cancer at an early age (younger than 65).Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

After these discussions, men who still want to be screened should get the PSA blood test. The digital rectal exam may also be used as a part of the screening, the cancer society says.

More information

For more on prostate cancer, visit the American Cancer Society.

New Study Says Men Should Masturbate 21 Times a Month—Here’s Why 

Male masturbation jokes always get laughs in buddy movies and comedy routines. But a new study actually has something serious to say about the typical dude’s favorite shower activity: Masturbating frequently could significantly reduce a man’s risk of prostate cancer.

What qualifies as frequently? According to recent research from Harvard University, men who have 21 or more orgasms per month could cut their odds by 33%.

RELATED: 12 Things Men Must Know About PSA Tests

To reach these findings, researchers surveyed 31,925 men, sending them questionnaires about how often they engaged in self-love. The study team then tracked the participants for 18 years, recording which men developed prostate cancer in that time period. The men were assessed at three different points: the year before the questionnaire was distributed, in their 20s, and again in their 40s.

The study conclusion? More frequent rates of masturbation were associated with lower rates of prostate cancer. 

Granted, this isn’t the first study to find that regular climaxes can help keep things healthy down there. But it is the first time researchers came up with an actual solo sex quota.

RELATED: 6 Reasons Masturbating Should Be a Part of Your Self-Care Routine

Despite this study and other research, experts still aren’t entirely sure why orgasms are a key to better health. Many doctors, including Ian Kerner, PhD, a psychotherapist and sexuality counselor in New York City, believe that ejaculation might flush out harmful toxins and bacteria, which would otherwise build up in the prostate.

But masturbation isn’t the only way to do that, Kerner points out. “There isn’t a difference in whether the ejaculation happens via masturbation or with a partner,” he says. “So making sex a priority is also helpful.”

 

Beyond the prostate flush, Dr. Kerner says masturbation comes with a whole slew of benefits, such as giving a dude the chance to experience pleasure and relaxation. “It’s an opportunity to engage in self-care,” he explains. “Masturbation can also be a healthy distraction mechanism and a natural way of regulating anxiety.” 

Of course, masturbating at least 21 times a month certainly isn’t a surefire way to avoid prostate cancer. Kerner also recommends sticking with a plant-based diet, incorporating plenty of fish rich in Omega-3 fatty acids, and “consuming red foods such as tomatoes that are rich in lycopene, as well as soy products that contain isoflavones.” He also advises getting regular physicals that include a prostate exam, and plenty of exercise.