The U.S. Preventive Services Task Force recently revised its recommendation for prostate cancer screening. The new recommendation is that men discuss the screening with their doctors, changed from the 2012 recommendation against widespread screening. Physicians must still help patients make a tough decision.
The task force revised its recommendations because of some new data from a large European study of prostate cancer. It found that screening could help prevent about one death per one thousand screened for prostate cancer. But the message is that screening can also lead to unnecessary testing and treatment. Dr. Joseph Renzulli, a urologist for the Lifespan hospital system, says he and his colleagues have been more cognizant of those dangers.
“And so urologists identified that, yes, we are being too aggressive in treating these low risk cancers," said Renzulli." So we started to observe low risk prostate cancer that was diagnosed and only treat those who show progressive features over time.”
He says he supports the new recommendations, but not the part that lowers the outside age for screening from 75 to 70. He says he has many patients 70 and older who are in good health and could benefit from treatment.
Renzulli says the new recommendations mean that primary care and other doctors should be having a different kind of conversation about screening for prostate cancer with their patients.
“Physicians have to start having a shared decision, educating patients and having them decide whether they want to be screened, versus just deciding as the physician, well, I believe in screening, or I don’t, therefore all my patients are going to be screened versus all my patients aren’t going to be screened," said Renzulli.
Renzulli says more screening can lead to unnecessary tests and treatment. He says doctors should not aggressively treat all prostate cancers because some are "indolent," or unlikely to lead to death. And treatment can cause serious side effects.