Since doctors began following new guidelines about screening tests for prostate cancer, fewer men are getting tested — and fewer early-stage cases are being detected, two new studies find.
In 2012, the U.S. Preventive Services Task Force concluded the prostate-specific antigen (PSA) test was doing more harm than good, prompting unnecessary surgery, radiation treatments and side effects among men who faced little risk of dying from the cancer that is, in the majority of cases, slow-growing.
The panel of independent experts selected by the government recommended the test should be avoided except for those classified as being at high risk for the disease, such as African-American men and men with a family history of the cancer.
Since that recommendation, both screening and early-stage detection have declined, according to the studies appearing in the Journal of the American Medical Association.
That's a worrying trend, says David Penson, M.D., at Vanderbilt University in Nashville, Tenn.
"The incidence of prostate cancer is dropping, but this doesn't mean that the cancer is not there, it just means we're not finding it," says [subscription required] Penson, author of an editorial accompanying the published studies.
One study showed rates of PSA screening dropped by 18 percent between 2010 and 2013 among men 50 years of age and older.
The incidence of early-stage prostate cancer detection among this age group also dropped, from 498 per 100,000 men in 2011 to 416 per 100,000 men in 2012.
A second study found a similar drop in screening among men aged 60 to 64.
The decline in screening may be a positive sign if it's the result of men and their doctors discussing the pros and cons of screening and arriving at informed decisions together, says Otis Brawley, chief medical officer for the American Cancer Society and an author of one of the studies.
It's less positive if doctors have simply reduced the number of screenings based on the guidelines, he says.
"It's only a good thing if [the numbers] went down because doctors and patients consciously decided together that it shouldn't be done," Brawley says.
"I think it's terrible to tell a man he must get screened," he added. "I think it's terrible to tell a man he can't get screened."
Penson acknowledges that doctors have been "overly aggressive" in both screening for prostate cancer and embarking on treatment over the last two decades.
In the case of many of those diagnoses, the treatment was likely not necessary, he says.
"With PSA testing, we often detect cancers that don't need to be treated — clinically indolent, meaningless cancers," he explains. "It is true that more men die with prostate cancer than of it."
Prostate cancer screening should not be an all-or-nothing proposition but rather should be tailored to a patient's individual level of risk and his preferences, he says.
The PSA remains an imperfect test, he notes.
"But we can do better with it."
