Whether to screen men for prostate cancer has been a controversial topic for at least 20 years. Many clinicians have believed that finding a tumor early and cutting it out is the best possible way to treat prostate cancer, just as it is for most tumors.
Critics of the screening have argued that many prostate tumors grow so slowly that the patient is likely to die of other causes before the tumor becomes a threat. They contend that early treatment can cause more damage than leaving the tumor alone. Now, two major and long-awaited studies show that screening men for prostate cancer provides little or no benefit in saving lives and can lead to painful, debilitating and expensive medical treatments without any obvious benefit.
The newest findings, released Wednesday, would seem to support the stance of the critics. But doctors — and patients — are cautious. And though the new results may seem definitive, experts say they’re still not clear-cut enough to recommend against screening for prostate cancer. As such, the decision to screen is likely to remain one made by doctor and patient, with both unsure whether or not the test is prudent or risky.
The first report, on an American study of 76,000 men, found no mortality benefit from screening. The second report, on a European study of 162,000 men, found a 20% reduction in deaths — which was only barely significant statistically because of the small number of deaths on which it was based. Both reports were published online in the New England Journal of Medicine.Even with the reduction found in the European trial, it was necessary to screen 1,400 men and treat 48 cancer cases to save one life.
“What the European study tells us is that, if you are a man who chooses screening, you are 47 times more likely to be harmed . . . than to have your life saved,” said Dr. Otis W. Brawley, chief medical officer of the American Cancer Society.