NEW YORK--The benefits of prostate cancer screening are greatest
among men whose overall life expectancy is more than 10 years.
In a talk at Lenox Hill Hospital, John A. Fracchia, MD, said that
the increased incidence and mortality of prostate cancer over
the past half century underscore the importance of early detection
in successful treatment.
Dr. Fracchia, clinical associate professor of urology, Cornell
University Medical Center and chief of urology at Lenox Hill,
outlined what he termed a rational approach to the early detection
of prostate cancer. Even with its shortcomings, prostate-specific
antigen (PSA) testing has revolutionized the field, but he cautioned
that guidelines for its use are essential.
He recommended that screening be made available to all men with
life expectancy and functional capacity of 10 years or more, to
those at high risk, and, lastly, to anyone outside these two groups
who requests it.
Annual digital rectal examination in combination with PSA testing
is the most effective screening mode for men over age 40, Dr.
Fracchia said. Transurethral ultrasound is recommended only in
the event of abnormal findings from either of these two tests.
Prostatic acid phosphatase (PAP) testing is no longer regarded
as worth doing, he commented.
He noted that more widespread screening results in too many positive
diagnoses of prostate cancer, which in turn leads to too much
treatment and excessively high medical costs.
Nationwide, prostate screening alone costs a staggering $11.88
billion annually. Men whose life expectancy for other reasons
is less than a decade are needlessly subjected to diagnostic and
treatment procedures that will not prolong their lives. "Most
prostate cancer patients die with, not from, prostate cancer,"
Dr. Fracchia said.