ELDERLY AND AFRICAN MEN AT INCREASED RISK OF HIGH RISK PROSTATE CANCER 

NEW YORK (Reuters Health) Feb 14 - Even though the U.S. Preventive Services Task Force (USPSTF) recommends against prostate-specific antigen (PSA) screening, researchers said Tuesday at a large conference that maybe some men still should be having the test.

But USPSTF co-vice-chair Dr. Michael LeFevre, of the University of Missouri School of Medicine in Columbia, came down hard against their conclusions.

The new data, from a registry study, showed that men aged 75 and older, and African American men of any age, more often have intermediate or high-risk prostate cancer discovered on PSA testing, researchers reported at the 2013 Genitourinary Cancers Symposium in Orlando, Florida.

While the new data are only observational, the researchers -- and Dr. Bruce J. Roth, from Washington University School of Medicine in St. Louis, Missouri, who moderated a press conference for reporters - believe the question of PSA screening should remain open.

"In the debate about prostate cancer screening, there are no absolutes," Dr. Roth said. "There is no simple answer."

Lead investigator Dr. Hong Zhang, from the University of Rochester Medical Center, Rochester, New York, told Reuters Health, "I agree that the PSA test is not the perfect assay to detect prostate cancer, but we have nothing else at this time."

But her data don't sway Dr. LeFevre, who insists that prostate cancer screening causes harms.

"The false positive rate is high, leading to unnecessary biopsies and the associated complications, and treatment of prostate cancer carries with it significant risk of major health problems, including premature death," Dr. LeFevre told Reuters Health. "The question is whether the benefit of finding cancers before symptoms are present through PSA screening outweighs those harms."

"The USPSTF concluded that the benefit does not outweigh the harms," he said. "This is particularly true for men over age 70 years for whom no randomized trial of screening has demonstrated any benefit, and the two studies of prostatectomy for cancers detected either with or without screening also showed no benefit in this age range."

Dr. Zhang's team used the Surveillance, Epidemiology, and End Results (SEER) database to identify men with American Joint Committee on Cancer (AJCC) stage T1cN0M0 prostate cancer diagnosed between 2004 and 2008.

Of the 70,345 men they identified, 47.6% had low-risk disease (as defined by a PSA <10 10="" 16.5="" 20="" 35.9="" 6="" 7="" a="" and="" disease="" gleason="" had="" high-risk="" intermediate-risk="" mg="" of="" or="" score="" to="" up="" with="" without="">20 mg/L, with or without a Gleason score of 8 or more).

Men 75 or older were almost 4.5 times more likely to have intermediate-risk prostate cancer discovered on screening (odds ratio 4.47, p<0 .01="" 1.50="" 1.84="" 10="" 50="" 9.39="" african="" aged="" almost="" also="" americans="" and="" cancer="" compared="" disease="" for="" had="" have="" high-risk="" increased="" intermediate-risk="" likely="" men.="" men="" more="" odds="" or="" p="" prostate="" times="" to="" white="" with="" younger.="">

"While men who are older than 75 account for 11.8% of the population at risk, they accounted for 24.3% of intermediate and 26.1% of high risk disease," Dr. Zhang said.

But Dr. LeFevre counters, "We do not need to detect asymptomatic prostate cancers of any grade unless we know that early detection and treatment prolongs life. We have no science to support that assertion in men over age 75. For younger men, the USPSTF concluded that the very small possibility of benefit does not outweigh the harms."

The 2013 Genitourinary Cancers Symposium was co-sponsored by the American Society of Clinical Oncology, the American Society for Radiation Oncology, and the Society of Urologic Oncology.