The number of American men likely to be diagnosed with prostate cancer in the coming year is down to about 160,000. That number is a dramatic decline from the 180,000 annual cases anticipated only a year or so ago. While the decrease might seem like news worth celebrating, many medical professionals say that simply may not be the case. The decline comes at a time when the number of people obtaining routine screening is also on the downfall along with the number of biopsies and prostatectomies performed in the United States. Over the long term, some healthcare providers fear, this downward trend could produce a higher mortality rate associated with this disease that had largely been brought under control thanks to aggressive awareness campaigns to promote early screening.
So, what changed?
Back in 2012, the U.S. Preventative Services Task Force issued new recommendations related to the most common prostate cancer screening tool. Citing its high inaccuracy rate and the number of biopsies that were performed and found to be unnecessary, the task force essentially took the prostate-specific antigen test off the table. This routine blood test screens for a biomarker commonly associated with prostate cancer. Elevated levels of PSA may indicate the presence of cancer, resulting in a biopsy. Far from infallible, the PSA does have a high false positive rate. Even so, it remains one of the most effective tools for finding prostate cancer early, in its most treatable forms.
While some researchers and clinicians have argued the PSA remains a valuable screening tool, especially if results are confirmed through second and even third tests, before a biopsy is performed the task force’s recommendation stands. As a result, many doctors are not offering this test to help screen for prostate cancer. In addition, the number of digital rectal exams for prostate cancer screening has gone down since the recommendation was made. Not surprisingly, the number of biopsies and prostatectomies has also declined right along with the diagnosis rate.
The task force’s recommendation was made to help spare men the side effects associated with biopsies, especially if the procedure turns out to have been unnecessary. While well-intentioned, some fear the drop in screening rates may result in a higher diagnosis rate of advanced stage prostate cancer in the very near future. The mortality rate would likely rise, as well.
As turmoil remains strong in the medical community in regard to prostate cancer screening, men are still urged to speak with their doctors about their personal risks. Clinicians with high-risk patients are urged by many in the profession to consider screening recommendations on a case-by-case basis. Detecting higher risk prostate cancer early remains crucial for providing the best possible outcomes for a patient.