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

Posted April 13, 2017

A federal task force is walking back a 2012 recommendation that men between ages 55 and 69 not be screened for prostate cancer. PSA testing reduces the risk of dying of prostate cancer, but there is no evidence it reduces the risk of dying. "Other men will realize the likely benefit is small and aren't willing to risk the harms", she said.

A recent study proved that a screening process based on PSA levels could accurately predict the development of prostate cancer way before the problem is detected.

And if someone has a slow-growing prostate cancer that doesn't necessarily need treatment, the emotional distress of a cancer diagnosis shouldn't be underestimated, Turini said. Ultimately the goal of the PSA test is to identify cancer earlier on before it becomes terminal.

The new draft guidelines echo those of several leading medical groups. The biggest remaining difference is timing.

In a draft guideline released today, the task force takes the position that for men aged 55 to 69, the decision to undergo screening "is an individual one".

"I'm very pleased. I view this as a victory for PSA screening for prostate cancer", says Dr. William Catalona, a professor of urology at the Northwestern University Feinberg School of Medicine. At the same time, the specialty group took issue with the panel's decision to maintain its recommendation against screening for men 70 and older, saying that healthier older men might benefit from the test. In 2012, it recommended clinicians "discourage the use of the service" because of a "moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits". Read the new advice here.

"Screening programs may also prevent up to 3 cases of metastatic prostate cancer per 1,000 men screened over 13 years", the statement says. When it appears in middle-aged men, it frequently develops so slowly that it's rarely the cause of death, so treating it with invasive and toxic therapies like surgery, chemotherapy and radiation often exposes men to more side effects and harms without protecting them from dying from that cancer.

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But the results of research from the last five years have changed that equation, the task force says.

PSA screening, then, is like a dentist applying a sealant to one of your 32 teeth, and that sealant reduces the risk of losing the treated tooth by 20 percent.

Prostate cancer is so common that one published 2015 study reported more than one-third of white men and one-half of black men ages 70 to 79 were found to have previously undiagnosed prostate cancer on autopsy.

"They should be aware that the PSA test is a screening test for prostate cancer, it might have a false elevation but it's the only test we have that's blood-based that can detect prostate cancer clearly", said Brandt.

"The importance of PSA testing is that it's bringing men into contact with the healthcare system", said Dr. Ramon Perez, an urologist and advisor to MHN. Marsha Blackburn, R-Tenn., and Bobby L. Rush, D-Ill., introduced legislation to "reform" the independent panel and add specialists to the prevention experts appointed by a federal health agency. Their advice influences both physicians and insurance coverage (both public and private insurance)-as the Affordable Care Act covers preventive screenings rated as A or B. Following a well-established process, it reviews the scientific evidence, issues a draft guideline for the public and solicits comment.

Why is the task force now recommending a change?

USPSTF said patients are more likely to experience AEs than receive a benefit.

For men between the ages of 55 and 69, getting screened for prostate cancer is a mixed bag of possible, down-the-road benefits and just-as-possible immediate harms. 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. In 2008, the group said there was too little evidence to make any kind of recommendation for younger men but said those 75 and older shouldn't be screened. In addition, new research has shown that preventative actions such as repeated PSA testing can help men diagnosed with cancer avoid overtreatment. That initial report drew some controversy, including from screening advocates who urged that the panel's report reflect stronger confidence in the lifesaving benefits of the PSA test.