美国国家公共电台 NPR Federal Task Force Softens Opposition To Routine Prostate Cancer Screening（在线收听）

RACHEL MARTIN, HOST:

There's big news today about one of the most common forms of cancer. An influential federal task force now says patients and doctors should discuss screenings for prostate cancer. NPR health correspondent Rob Stein has more.

ROB STEIN, BYLINE: Almost 180,000 American men are diagnosed with prostate cancer each year and at least 26,000 die from the disease. So it was a big surprise five years ago when the U.S. Preventive Services Task Force announced men should not routinely get a blood test, the PSA tests that could catch prostate cancer early. Kirsten Bibbins-Domingo, who chairs the task force, says there was a good reason.

KIRSTEN BIBBINS-DOMINGO: We decided that on balance, while there's benefits of screening, that the benefits did not outweigh the harms.

STEIN: Harms like false alarms that require painful, dangerous biopsies, often followed by surgery and radiation that frequently leaves men impotent and incontinent, all for tumors that often grow so slowly, they would never become a problem.

BIBBINS-DOMINGO: The PSA test is not a great test. It doesn't help us distinguish the types of cancers that are going to kill you from those cancers that are going to not progress over time and will not cause a man health problems.

STEIN: But Bibbins-Domingo says new research has changed that equation. A big European study found PSA testing cuts the chances of getting advanced prostate cancer and dying from the disease by about 20 or 30 percent. At the same time, more men who find out they have prostate cancer are deciding with their doctor's advice to just keep an eye on it, reducing the harms of screening.

BIBBINS-DOMINGO: We think now the benefits do outweigh the harms, that there's a small net benefit from screening. And therefore, what we are recommending is that doctors and patients talk together about whether screening is right for them.

STEIN: Now, the task force says the risks of screening still outweigh the benefits for men age 70 and older, and they should not get screened. And the potential benefits for younger men are still pretty small, saving maybe one or two lives out of every thousand men who get screened. And the chances of ending up incontinent and impotent are still pretty big.

BIBBINS-DOMINGO: There are some men who might say, you know, I really want to avoid dying of prostate cancer. That's the most important thing to me. So even if there's a small likelihood that this will work, I want to do it. There are other men who might say, you know, my likelihood of benefiting from the screening is still small, and I'm not willing to risk the things that may happen along the way.

STEIN: Doctors like William Catalona, who have long advocated aggressive PSA testing, are pleased by the change. Catalona is a urologist at Northwestern.

WILLIAM CATALONA: PSA screening saves lives. I view it as a victory for PSA screening for prostate cancer.

STEIN: But others aren't so sure. Daniel Merenstein of Georgetown University thinks the new guidelines are confusing and unrealistic.

DANIEL MERENSTEIN: What I'm afraid of is that physicians rather than have this discussion, 'cause it's a difficult and long discussion, will just order this test like they do, you know, a cholesterol panel. And that will cause many more harms than good. And the task force clearly does not want that. But I think, in reality, that's how things work.

STEIN: But Otis Brawley of the American Cancer Society says the new recommendations would get it about right.

OTIS BRAWLEY: I really do think that there is a pendulum in a lot of things that we do in medicine. And the pendulum here may be getting to the right place where we realize there are harms and there are benefits. And individuals need to weigh these harms and benefits and tailor a decision that's right for them.

STEIN: The task force is taking public comment on the new recommendations before making them final, probably within the next year. Rob Stein, NPR News.