New guidelines urge fewer prostate screenings

LOS ANGELES — New guidelines for prostate-cancer screening issued Wednesday emphasize that physicians should better educate men about the risks and benefits of using the PSA test for screening.

They also call for cutbacks in the use of digital-rectal exams to find tumors and recommend the end of mass prostate-screening programs at health fairs and other sites.

The revised guidelines issued by the influential American Cancer Society come on the heels of several studies suggesting that large numbers of tumors identified by PSA screening are inconsequential and that biopsies and treatment produce more harm than those tumors would.

Because of such findings, the new guidelines emphasize the importance of physicians explaining risks and benefits to the patients more fully so that each man can make an informed decision about whether to get tested.

Perhaps recognizing that physicians are unlikely to invest greater amounts of time in such educational efforts, however, the society also urged greater use of education specialists, pamphlets, videos and other materials to explain the risk-benefit trade-offs.

The panel that issued the guidelines called for cutbacks in community-screening programs because such educational efforts are rarely, if ever, incorporated.

The group also downplayed the importance of digital-rectal examinations — unpleasant procedures that were once a mainstay of physical exams for men older than 50 but which have become less common in recent years — because of lack of evidence that they save lives.

Dr. Otis Brawley, chief medical officer of the American Cancer Society, said the new guidelines are not that different from ones issued in 1997 and 2001.

"I think [earlier panels] meant to say what we are saying now, but they were interpreted by people to say we were encouraging screening," he said. "They were trying to encourage informed decision making."

Now, he added, "we have two clinical trials that very vividly illustrate the uncertainties associated with screening," which makes it even more important for men contemplating the PSA tests to understand the risks. Those major trials showed that PSA screening does not lower the risk of death from prostate cancer and might increase it slightly, perhaps from unnecessary treatments.

Dr. S. Adam Ramin, a urological-oncology specialist at St. John's Health Center in Santa Monica, Calif., said the cancer-society guidelines place too much emphasis on whether the tests save lives and not enough on whether they prevent complications from tumors, such as leaking of urine, incontinence, bone pain, anemia and weight loss.

"Although it is true that treatment will not necessarily save a lot of lives, it does prevent complications," he said.

Other experts noted that the treatment can produce complications such as urinary incontinence and impotence.

Skip Lockwood, president of Zero: The Project to End Prostate Cancer, said calls to end the digital-rectal exam are "kind of nuts. ... The whole concept that you would do anything to reduce the amount of information you have does not make sense to me."

Several medical groups, including the American Urological Association and the National Comprehensive Cancer Network, offer guidelines on screening with the PSA test, which measures levels of a tumor-associated protein in blood.

In broad terms, they all agree: Men should be offered the option of PSA screening when they reach 50, or at a younger age if they have a family history of prostate cancer.

If the test shows a low level of PSA, the groups generally recommend repeat screening every couple of years. If it is slightly elevated, they should be retested yearly.

Prostate cancer is the most common cancer in men after skin cancer, affecting 192,000 men each year and killing 27,000. While all the parties may not agree on how and how often PSA screening should be used, they are in unanimous agreement on one point. As Lockwood said, "We need a better test."

Prostate drug

extends lives

For the first time, an experimental drug has extended the lives of men with advanced prostate cancer who are no longer responding to other treatments and are out of options for fighting the disease, a company-led study found.

The benefit was modest — an extra 10 weeks — but cancer specialists were excited because no chemotherapy until now has been shown to boost survival in such men. Like any new drug tested on worst-case patients, there are hopes it will do better when tested in men who aren't as sick.

The drug is cabazitaxel, made by the French company Sanofi-Aventis. The federal Food and Drug Administration has said it will give it a quick review, which means it could be on the market soon.

In the study, the drug reduced the risk of dying during roughly one year of treatment by 30 percent, compared to another chemotherapy medicine that eases symptoms but does not prolong life, said Dr. Oliver Sartor of New Orleans' Tulane University.

The results of the study will be presented Friday at a meeting of the American Society of Clinical Oncology and several other groups. The study was sponsored by Sanofi, and most of the researchers work or consult for the firm.

Sanofi would not give a price estimate for the drug, which it plans to name Jevtana.