Aug. 31 (Bloomberg) -- Prostate-cancer therapies for men who didn’t need treatment cost at least $40 billion during two decades in the U.S., according to a Dartmouth Medical School researcher.

The majority of 1.3 million men whose prostate cancer was found because of increased screening between 1986 and 2005 didn’t benefit from the treatment they received, researchers said today in a study in the Journal of the National Cancer Institute. The cost of the treatment was estimated in an interview by H. Gilbert Welch, the study’s lead author.

The research found a sharp rise in the number of men who were treated for prostate cancer over two decades starting in 1986, just before the PSA blood test for prostate cancer came into use. The findings add to a debate over the value of the PSA test and similar efforts to find diseases and treat them early. Welch and other critics say such efforts lead to more tests, more surgery and more patient anxiety, while inflating costs.

“Prostate cancer is the poster child for this problem,” said Welch, a researcher at the Dartmouth Institute for Health Policy & Clinical Practice in Lebanon, New Hampshire, in an Aug. 28 telephone interview. He said 1 million men were treated needlessly because they would “never go on to develop symptoms or die from the disease. They will die with the disease, not from it.”

26 Percent Rise

The number of men diagnosed with prostate cancer began rising in 1987, the year after the publication of a widely publicized study on the use of the PSA test, the new research found. For the next five years, the rate increased an average of 12 percent annually, peaking in 1992. During 20-year period through 2005, the number of annual prostate cancer diagnoses rose 26 percent, the study found.

The PSA, or prostate specific antigen, test, measures the level of a protein in the blood of patients. While research has shown that PSA levels are higher in men who have cancer cells in their prostate, the test by itself can’t detect cancer, Welch said. Men who have elevated PSA tests are often urged to have a biopsy, a procedure that removes bits of tissue from the prostate to look for the presence of cancer cells.

Biopsies are often not conclusive in showing that a patient has cancer cells that pose an actual threat, Welch said. Despite that, patients who have positive biopsies are often urged to have surgery or other procedures to treat the cancer, he said.

‘Unnecessary Treatment’

“Prostate cancer screening has resulted in substantial overdiagnosis and in unnecessary treatment,” said Otis Brawley, chief medical officer for the Atlanta-based American Cancer Society, in a commentary accompanying Welch’s study. “It may have saved relatively few lives.”

Prostate cancer screening was promoted in public campaigns such as Prostate Cancer Awareness Week and by hospitals and health systems that “stood to profit from prostate cancer screening and treatment and encouraged it, implying benefit to those screened,” Brawley said.

The U.S. Preventive Services Task Force, a government panel of experts, recommends against screening for prostate cancer in men 75 or older. The panel takes no position on screening younger men, saying there isn’t enough evidence of benefits or harms to support a recommendation.

The study was criticized by William Catalona, a urologist and prostate cancer surgeon at Northwestern University’s medical school in Chicago and a pioneer in use of the PSA test.

Drop in Death Rate

Before the PSA test made widespread screening for prostate cancer feasible, “more than half of cancers were diagnosed after they had spread beyond the prostate,” Catalona said in a telephone interview today. “In the PSA era, prostate cancer is detected at an earlier stage and the U.S. age-adjusted prostate cancer death rate has decreased by 40 percent between 1993 and 2006.”

Welch and his colleagues “tilted the balance” by choosing to start the study at a time when prostate cancer diagnoses were rising for reasons other than screening, Catalona said.

“They designed the study to make overdetection seem larger than it is and make the life-saving benefits seem smaller than they are,” Catalona said. “It’s going to discourage doctors and patients from using prostate cancer screening.”

Use of screening campaigns to find and treat cancer in men who aren’t showing symptoms stems from “a culture within medicine that says it’s always better to look for early forms of disease,” Welch said. “This is part of the war metaphor in fighting cancer and it tends to ignore the collateral damage or friendly fire incidents that are unintended consequences of this strategy.”

These consequences include the fear men may feel when they are told they have cancer and the side effects of surgery, which include impotence, incontinence and sometimes loss of bowel control, Welch said.

To contact the reporter on this story: Rob Waters in San Francisco at rwaters5@bloomberg.net.

Last Updated: August 31, 2009 17:39 EDT