Fewer men are being screened for prostate cancer, and fewer early-stage cases are being detected, according to two studies published in the Journal of the American Medical Association.
The number of cases has dropped not because the disease is becoming less common but because there is less effort to find it, the researchers said.
The declines in both screening and incidence “could have significant public health implications,” the authors of one of the studies wrote, but they added that it was too soon to tell whether the changes would affect death rates from the disease.
The decrease in testing is almost certainly the result of a recommendation against screening made in 2012 by the United States Preventive Services Task Force.
Because prostate cancer often grows slowly, the panel said, screening finds many tumors that might never have harmed the patient. But they are treated anyway. As a result, it concluded, testing saves few lives and leads too many men into unneeded surgery or radiation, which often leaves them impotent and incontinent.
An editorial accompanying the articles, by Dr. David F. Penson, the chairman of urologic surgery at Vanderbilt University Medical Center, acknowledged that too much screening can do harm but suggested that the pendulum has swung too far the other way.
Rather than issuing a blanket recommendation against screening, Dr. Penson said, it would be better to “screen smarter” by testing most men less often and focusing more on those at high risk.
“With P.S.A. testing, we often detect cancers that don’t need to be treated — clinically indolent, meaningless cancers,” Dr. Penson said in an interview. “It is true that more men die with prostate cancer than of it.”
He said the recognition that many prostate cancers were indolent, or slow-growing, and not deadly had led to major changes in medical practice, making doctors less inclined to automatically operate if cancer is found.
Dr. Penson said that when active surveillance is explained, “of course men look and say, ‘that would be great if I can avoid having surgery or radiation. If you think this cancer is not a problem, Doc, I’ll take that every day and Sunday.’ It’s not hard to convince patients,” Dr. Penson added.
The cancer society recommends that men discuss screening with their doctors to decide whether they should have it.