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

7 2017 Dr. Kirsten Bibbins Domingo poses at her office in San Francisco. Draft recommendations from the US Preventive Services Task Force ditch the old advice against PSA screening and say

Medical opinion about prostate cancer screening inched closer to harmony with an updated draft recommendation from the U.S. Preventive Services Task Force (USPSTF) supporting discussion-backed decisions for men, ages 55 to 69. "The patient advocacy community, the research field, and the doctors who treat prostate cancer patients every day must stand united that testing saves lives, and we must support and advance research to compel the USPSTF to improve its recommendation again".

"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", Dr. Alex H. Krist, a member of the task force and associate professor of family medicine and population health at Virginia Commonwealth University, said in a statement.

The task force is an independent, volunteer panel of experts in prevention and evidence-based medicine that makes recommendations about preventive medical services, such as screenings, counseling services, and preventive medications.

The new draft guidelines echo those of several leading medical groups, but they don't make the decision any easier for men: With their doctor's help, they have to decide whether to take an imperfect PSA test that carries a small chance of detecting a deadly cancer and a larger chance of triggering unneeded worry and treatment with serious side effects. Medicare and many private insurers have continued to pay for the screening.

The PSA test measures the level of a protein that, when elevated, can mean prostate cancer is present. It does not recommend earlier testing for blacks and those with a family history but says they should know their risks are higher. They just have a high PSA level.

"The other thing we have now is evidence that three men who would have developed metastatic prostate cancer won't have metastatic prostate cancer with screening", he added. The potential harms of screening include frequent false-positive results, which can result in immediate, additional testing, and years of additional close monitoring with repeated blood tests and biopsies.

Indeed, it is fair to say the harms of prostate screening are better proven than the benefits, although benefits likely do exist. All public comments will be considered as the Task Force develops its final recommendation and final evidence review. I was diagnosed when I was 48 years old.

"We've been jumping up and down about this for years and years", Dr. Benjamin Davies, an associate professor of urology at the University of Pittsburgh School of Medicine, told CNBC.

Based on longer follow-up of studies, "the task force is backing off from, 'Do not screen, ' to 'Let's talk about it, ' and then, I would say, in time, it will probably come to, 'We think you should do it, '" he said. Prostate cancer is the most common cancer in American men; the American Cancer Society projects more than 161,000 new cases this year in the US, with about 26,730 deaths.

The draft recommendation was published on the task force's website on April 11, and it is open to public comment until May 8.

Bottom line: 1,000 men screened, one prostate-cancer death averted in that time. Preventive screenings rated A or B by the Task Force are covered by the Affordable Care Act. The recommendations say nothing about men under 55, for whom some groups do recommend screening in some circumstances. The next step is often radiation or surgery to remove the prostate, which may result in impotence and incontinence.

Clinicians are recommended to discuss with patients who have a family history of prostate cancer-especially those with a father or brother diagnosed with prostate cancer-about the higher risk of developing the disease. The panel concluded, in its new guidance, that the potential benefits of screening slightly outweighed the harm.



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