Left Behind in Prostate Cancer Screening

By NICHOLAS BAKALAR

13 jan 2009 --Prostate cancer screening has substantially increased early detection of the disease, but a new study suggests that too few low-income men are being screened.

The analysis, to be published in the February issue of The Journal of Urology, examined the medical records of 570 men who had received treatment for prostate cancer in a program for the poor and uninsured in California. It found that metastatic, or spreading, and other high-risk cancers were more common among them than in the general population.

Over a five-year period through June 2006, about 19 percent already had metastatic disease at the time of diagnosis, compared with just 4 percent nationally. By contrast, low-risk cancers were far more common among more affluent men, suggesting that they were being screened more often.

“In prostate cancer, there’s a lot of talk about overdetection and overtreatment,” said Dr. David C. Miller, the lead author and an assistant professor of urology at the University of Michigan. “But this study says that in these very disadvantaged men, there is underdetection and undertreatment, that the cancers are not being found early enough.”