Medicine

Prostate Cancer Tests are Now OK With US Panel, With Caveats

Prostate Cancer Tests are Now OK With US Panel, With Caveats

The USPSTF bases its recommendations largely on prospective trials, which the scientific community doesn't have a lot of in the area of prostate cancer screening.

The stance marks a reversal from the panel's recommendation in 2012, when it concluded that the adverse effects of the blood test outweighed its benefits. Medicaid and many insurers cover PSA screening.

"There is probably a small benefit overall to screening", said task force chair Dr. Kirsten Bibbins-Domingo.

"Unfortunately, the C rating is still insufficient and risky for high-risk men or men who - without testing - will develop aggressive or advanced disease", said Bearse.

The harms include stressful false alarms that often lead to painful and sometimes risky biopsies.

Catching cancer early is essential to treating unsafe and aggressive forms of the disease, which can be a benefit from the test. At least 60 men suffer urinary incontinence and sexual impotence from the treatment. "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".

"At risk patients (men with a family history and black men) are more likely to die from prostate cancer, therefore these individuals are conceptually more likely to gain from PSA screening", Trinh, who wasn't involved in the task force recommendations, said by email.

In the intervening 5 years, new data came to light, shifting the consensus pendulum in favor of a discussion-based approach, albeit slightly, said USPSTF member Alex H. Krist, MD. "So many men today are being diagnosed with later stage prostate cancer because they were not regularly screened".

Bottom line: 1,000 men screened, one prostate-cancer death averted in that time. Instead, they and their doctors are opting for "watchful waiting" or active surveillance of the malignancy.

The new guidelines are relatively simple: Men between the ages of 55 to 69 should start a conversation with their doctors about whether to have a PSA test and focus on their own values and priorities.

Bibbins-Domingo stresses that the task force has stopped short of urging screening for all young men.

About 70 percent of men with elevated PSA do not have prostate cancer when they are biopsied, according to research. "It is important that men, particularly African-American men, get a complete check-up, including the PSA". But doctors say advances in detection, and closely monitoring low risk cancers are helping men avoid drastic treatment.

Doctors who have long advocated aggressive PSA testing are praising the new guidelines.

"Prostate cancer is one of the most common cancers to affect men, and the decision about whether to begin screening using PSA-based testing is complex". It's also wrong to say that we should never do PSA testing because it has been shown to save lives.

"The USPSTF clearly utilized a more inclusive and transparent process in developing these draft recommendations", Babayan continued, alluding to criticisms of the lack of medical specialty representation on the task force. "If this were to continue, we would lose all these gains in reducing the prostate cancer death rate".

Q: What do other groups recommend?

Dr. David Penson, a urologist at Vanderbilt-Ingram Cancer Center, agrees with the task force's decision.

The new draft guidelines echo those of several leading medical groups.

"I think they punted", said Daniel Merenstein, a family-medicine physician at the Georgetown University School of Medicine.

Bibbins-Domingo said the largest European studies have generally screened every two to four years. "And that will cause many more harms than good".

Editor's note: Otis Brawley is chief medical officer of the American Cancer Society.


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