Task force recommendation on prostate cancer screening galvanizes imagers

Prostate cancer imaging proponents are advising physicians to follow recent federal recommendations against prostate cancer screening for men over the age of 75, but they say more government attention to care standards could lead to improved diagnosis and treatment.

Men 75 and older should not be screened for prostate cancer, while younger men should discuss with their physicians the pros and cons of the prostate-specific antigen test, according to the U.S. Preventive Services Task Force. The task force found evidence that screening in men 75 and older led to invasive, sometimes unnecessary procedures, such as biopsy and prostatectomy, that carry the risk of physical and psychological damage. Other complications include urinary incontinence and impotence.

Evidence was insufficient, however, to assess the advantages and downsides of screening in younger men. Results of two ongoing clinical trials, the National Cancer Institute's Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial and the European Study of Screening for Prostate Cancer (ERSPC), could shed more light on the potential benefits of screening in men under the age of 75, task force members said.

The PLCO enrolled about 60,000 men aged 55 through 74 from 1992 to 2001. Half of the subjects were randomized for screening until 2006, and follow-up will stop by 2016. The ERSPC involves nearly 200,000 aging males from eight European countries. Its results should be published by 2010.

The task force is an independent panel of experts sponsored by the Department of Health and Human Services' Agency for Healthcare Research and Quality. The report - and the evidence it is based upon - appeared in the Aug. 5 issue of the Annals of Internal Medicine (2008;149[3]:185-191).

The recommendation seems generally sound advice, but the need to act on the information should be considered carefully, said Dr. Clare Tempany, director of clinical MRI at Brigham and Women's Hospital in Boston. Age-related clinical issues have different variations.

Many healthy men of 75 will want to know and should know what their PSA levels are, said Tempany.

"It is the actions that occur afterwards that are of concern and require caution as men get older," she told Diagnostic Imaging.

Advanced MR, ultrasound, and nuclear medicine imaging have the potential to eliminate prostate cancer as a patient care crisis and as a socioeconomic problem, save lives, improve quality of life, and save at least $5 billion in healthcare costs, said Dr. Faina Shtern, president and CEO of the Advancement of Medical Technologies Foundation.

"Accurate imaging techniques will not only improve detection of prostate cancer but will eliminate more than 1.5 million unnecessary biopsies each year and about 50% of unnecessary treatments for men with early prostate cancer," Shtern said.

An intense debate raged in the 1990s about the value and utilization guidelines for film-based mammography in younger women. Although it was clear that mammography detected breast cancer earlier and saved lives, that debate played an important role in public education. It brought about the development of novel breast cancer imaging modalities and procedures that transformed breast cancer care, such as digital mammography, breast MRI, and image-guided stereotactic needle biopsy, according to Shtern.

The AHRQ report could stimulate a similar trend in prostate cancer diagnosis, Shtern said.

"I hope that the report of the AHRQ will have a similar impact on public demand and, ultimately, national investment in research to improve prostate cancer diagnostics, including more specific in vitro testing and imaging tools," she said.

In late June, the U.S. House of Representatives passed Resolution 353 calling for increased investment in prostate imaging and image-guided treatment. The task force recommendation was "particularly timely" in light of such a congressional move, Shtern said.

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