United States panel issues new guidance on prostate cancer screening

Prostate cancer tests are now OK with panel, with caveats

An MSK expert comments on a new US Preventive Services Task Force (USPSTF) guideline regarding a type of prostate cancer screening. Regarding the USPSTF's "D" rating for men over age 70, while we acknowledge that there is limited evidence in men in this age group and agree that many older men will not benefit from the test, we believe that selected older healthier men may garner a benefit from prostate cancer screening and should therefore talk to their doctors about the benefits and risks of prostate cancer testing. For at-risk men, including men who are African-American, have a family history of prostate cancer, family history of breast cancer or the BRCA gene, and those who have been exposed to certain chemicals like fireman and veterans, as well as men over the age of 65 further assessment, is required.

The U.S. Preventive Services Task Force is a national independent volunteer panel of medical experts created in 1984.

The new draft guidelines released Tuesday 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 has a small chance of detecting a deadly cancer and a larger chance of triggering unneeded worry and treatment with serious side effects.

However, other medical groups such as the American Cancer Society have been more nuanced, continuing to recommend regular PSA testing while urging patients and their physicians to discuss the benefits and risks.

The PSA blood test can show elevated numbers for reasons other than prostate cancer, such as an enlarged or inflamed prostate or an infection.

These recommendations only apply to adult men who have not previously been diagnosed with prostate cancer and have no signs or symptoms of the disease. Because radiation and surgery may lead to impotence, bowel injury and problems with urination, some men may be uncertain about what to do with a positive test result.

"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. This recommendation is not yet final and is open for public comment. New research shows testing men aged 55 to 69 may slightly reduce their chances of dying from prostate cancer.

Dr. Krist is an associate professor of family medicine and population health at Virginia Commonwealth University and an active clinician and teacher at the Fairfax Family Practice Residency. Those conversations should start at 55.

In addition, the task force noted, an increasing number of men with low-risk cancer are opting for "active surveillance", which involves regular PSA testing, repeated rectal examinations and biopsies rather than aggressive treatment.

Critics of that recommendation anxious that as a result of any reduction in testing, prostate cancer might be diagnosed at a more advanced stage in some men. Some men who are concerned about prostate cancer will elect to be screened, and others who are less concerned will not; doctors should support either decision. The task force says screening is not recommended for men 70 and older.

"The new evidence allowed us to say that, on balance, we think now the benefits do outweigh the harms", says Dr. Kirsten Bibbins-Domingo, a professor of medicine at the University of California, San Francisco, who chairs the task force.

Davies estimated that, prior to 2012, bout 50 percent of men diagnoses with prostate cancer received unnecessary treatment. "This is a reasonable step back from the previous 'we don't recommend routine PSA screening, '" he said.

PSA-based screen and biopsies can not tell for sure which cancers are likely to be aggressive and spread or to grow so slowly as to never cause symptoms.

One specialist views the new recommendation as a correction of an error the task force made in 2012.



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