Medicine

Prostate cancer tests are now OK with panel, with caveats

Prostate cancer tests are now OK with panel, with caveats”

The new recommendation is a reversal from the one they issued in 2012, when the USPSTF advised most men not to get screened for prostate cancer using an low-cost blood test, called a prostate specific antigen (PSA) test.

But while some groups still recommend regular PSA tests, many have tempered their views.

For that group, the task force writes in its draft guidance: "the USPSTF recommends individualized decision-making about screening for prostate cancer after discussion with a clinician, so that each man has an opportunity to understand the potential benefits and harms of screening and to incorporate his values and preferences into his decision".

The USPSTF performed a systematic review of the existing evidence and concluded that the potential benefits and harms of prostate-specific antigen (PSA)-based screening are "closely balanced" in men aged 55-69 years and that it should be an individual decision whether to undergo screening or not (C Recommendation).

Yet "the balance of benefits and harms is still close", said Kirsten Bibbins-Domingo, an internist at the University of California at San Francisco and task-force chair. For men aged 70 and older, the recommendation for no PSA screening remains in place.

The guideline is not final and remains open for public comment until May 8.

Having every man undergo a PSA test every year is not what should be done.

The task force's 2012 advice against screening said there was little evidence that PSA screening was reducing deaths.

The draft recommendation that the screening holds some potential benefit for men 55 to 69 is a reversal of the USPSTF 2012 controversial recommendations against the screening. One epidemiologic study suggests that more than 1 million American men received unnecessary treatment over the past 25 years.

But now that there is more evidence about the pros and cons of screening and treatment, Meigs said, a "primary care physician is probably the best one to have that conversation, someone who knows them and their entire situation".

Instead of subjecting themselves to the potential harms of biopsies and treatment, they instead worked with their doctors to receive more regular checkups and monitoring of their cancer and only started treatment if the tumors developed.

Specifically, the European Randomized Study of Screening for Prostate Cancer (ERSPC) found PSA testing cuts the chances of developing advanced prostate cancer by about 30 percent and the risk of dying from the disease by about 20 percent. Surgery and radiation can cause urinary incontinence and sexual impotence. "It's much easier to be binary ... than it is to be nuanced, but treatment in prostate cancer does need to be nuanced".

The Task Force is a government supported panel composed of national medical experts whose recommendations influence healthcare providers and both public and private insurance coverage decisions. An elevated level can be due to cancer but also can reflect a benign condition such as an enlarged prostate.

"It basically leaves it to the discretion of the primary care doctor, or the urologist, of any individual who wants to consider PSA-based prostate cancer screening, to them and the patient that they see", St. Clair Hospital Urologist Dr. Shailen Sehgal said. "So many men today are being diagnosed with later stage prostate cancer because they were not regularly screened".

However, the task force recommendations typically carry the most weight with doctors.

The fact that there are harms has been hard for many advocates of prostate cancer screening to accept.

NY real estate executive Stephen Fredericks, 63, is a proponent of PSA testing. African-American men, men with a family history of the disease, and men exposed to Agent Orange and some other chemicals are at greater risk.

AUA responds to USPSTF draft recommendations on screening for prostate cancer [news release].



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