Out of all three direct maternal male relatives (two uncles, one grandfather), my brothers had two that died of prostrate cancer that was highly malignant and spread throughout their bodies. So both my brothers are considered at high risk and they have to get PSAs every couple of years to check their number.
Both the uncle and the grandfather opted for no treatment when the cancer was diagnosed (they were pretty young in both cases) - both died horrible, prolonged and highly expensive deaths. I don't need to go into the repugnant details. Many cancers don't kill quickly, and a tumor on the spine is so unbelievably painful that you have to kill yourself or get it reduced.
Men who are at high risk should get this test. If the cancer is detected young they can get a biopsy and find out just how bad it is, then make the decision. Or if you have an elevated PSA you can wait a few months and see if it is going up. There are multiple options and these should be discussed with a knowledgeable physician.
Personally, if my husband's PSA goes up after 75 I won't worry too much. But EARLY prostrate cancer is another matter.
I think the recommendation is highly suspect because if you sorted out different age brackets you would come up with a different result. By lumping cancers detected after 75 (more common) with cancers detected in the 50s (rarer, but often more aggressive) the picture is very confused. The average male doesn't live to 85, so of course there won't be much of a difference in survival rates. If you did a good strong study on prostrate cancers picked up in the earlier years, you would see a 10 year survival rate difference.
I went in to my doctor's office today because we had a meeting set up after office hours about a new medical system we might try, and my doctor brought up this issue. He was highly negative about the recommendation and said that he felt that in many cases not to do the PSA was malpractice, and he'd use his own medical judgment. He said missing early, highly treatable cancers in younger persons was pretty much murder in his opinion, and that if he were ever forced to practice this way he'd opt to just retire.
Here are some stats on incidence by age:
http://prostate-cancer.emedtv.com/prostate-cancer/prostate-cancer-statistics.htmlThis page has stats on age at death of prostrate cancer:
http://prostate-cancer.emedtv.com/prostate-cancer/prostate-cancer-statistics-p2.htmlScroll down and look at the five-year survival rates separated by diagnosis at stage. You can't convince me that diagnosing this cancer early for people with a good chance of living 10 years otherwise isn't worthwhile.
Therefore I think the data as presented is somewhat dishonest - very few men would bother to seek extensive treatment for a cancer that wasn't causing them problems late in life. But that does not mean that giving PSA tests to men in their 50s and early 60s doesn't improve survival rates. Of course, if you are already very ill with something else, the picture changes.
Decisions such as these should be made clinically and individually.
Further, I believe that the studies done were designed to present a cost justification for NOT offering prostrate screening in some countries. US cancer survival rates have been running significantly above those of most European countries for some time. I don't know whether an unsubscribed user can "see" this Medscape article (reprint from 2007 Lancet Oncology), so I will quote the significant portion:
http://www.medscape.com/viewarticle/561737Survival was significantly higher in the United States for all solid tumors, except testicular, stomach, and soft-tissue cancer, the authors report. The greatest differences were seen in the major cancer sites: colon and rectum (56.2% in Europe vs 65.5% in the United States), breast (79.0% vs 90.1%), and prostate cancer (77.5% vs 99.3%), and this "probably represents differences in the timeliness of diagnosis," they comment. That in turn stems from the more intensive screening for cancer carried out in the United States, where a reported 70% of women aged 50 to 70 years have undergone a mammogram in the past 2 years, one-third of people have had sigmoidoscopy or colonoscopy in the past 5 years, and more than 80% of men aged 65 years or more have had a prostate-specific antigen (PSA) test. In fact, it is this PSA testing that probably accounts for the very high survival from prostate cancer seen in the United States, the authors comment.
Further analysis of these figures shows that, in the case of men, more than half of the difference in survival between Europe and United States can be attributed to prostate cancer. When prostate cancer is excluded, the survival rates decreased to 38.1% in Europe and 46.9% in the United States. For women, the survival rate of 62.9% for all cancers in the United States is comparable to that seen in the wealthiest European countries (eg, 61.7% in Sweden, 59.7% in Europe), and the slightly higher survival in the United States was largely due to better survival for colorectal and breast cancer, the authors comment.