Prostate cancer tests are now OK with panel, with caveats

Prostate screening has been a contentious issue ever since the prostate specific antigen, or PSA, test became available some 30 years ago.

A health panel with the United States government has decided that routine prostate cancer screenings can be done as long as the patient decides whether they want to or not after discussing it with their doctor.

However, the recommended age range for testing overlooks the benefit of PSA screening for men who are older and younger.

The panels says its latest recommendation is based on new evidence indicating that routine PSA blood tests can slightly reduce some men's chances of dying from prostate cancer. "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 draft recommendation will be open for public comments until May 8. "Additional research on prostate cancer in African American men should be a national priority".

The task force based the change on new evidence showing the benefits of screening, including reduced risk for disease-specific death and risk for metastatic disease. Preventive screenings rated A or B by the Task Force are covered by the Affordable Care Act. More studies on the potential benefits vs. harms of screening for prostate cancer are needed among men with a family history of prostate cancer. That's good news, because in the USA, more men are opting for active surveillance. But first, they should have a talk with their doctor about the pros and the cons of the PSA test. It is a highly respected, highly skilled group of public health experts who review scientific studies and make recommendations on disease prevention and screening.

With the new guidelines, the task force joins the American Cancer Society and the American Urological Association in encouraging men to discuss the benefits and harms of screening with doctors to make a joint decision.

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Meanwhile, Dr. Otis Brawley, the chief medical officer for the American Cancer Society, believes the guidelines strike the right balance.

"Some men who are very concerned about prostate cancer will elect to be screened, and others who are less concerned will elect not to be screened; either decision should be supported", he wrote. The next step is often radiation or surgery to remove the prostate, which may result in impotence and incontinence. "It's much easier to be binary ... than it is to be nuanced, but treatment in prostate cancer does need to be nuanced".

Indeed, the US Preventive Services Task Force is responding to increasing evidence of an improvement in pathological interpretation, which allows for better prediction of the cancers that do not need treatment. "The draft recommendations released today are thoughtful and reasonable, and are in direct alignment with the AUA's clinical practice guideline and guidelines from most other major physician groups". Fewer men are being diagnosed with early-stage disease, when it is more treatable, while more are being diagnosed with more aggressive harder-to-treat cancer.

PSA screening to detect the most common male cancer is among the most heated topics in men's health.

It's not a shift to be taken lightly: The task force is known for being conservative and orthodox in interpreting scientific data and trends in medicine. Medicaid and many insurers cover PSA screening.

Nearly 3 million American men are now living with prostate cancer.

NY real estate executive Stephen Fredericks, 63, is a proponent of PSA testing. There was promotion of screening, not just by doctors to their patients but by clinics, patient advocacy organizations and even an adult diaper manufacturer.

  • Marjorie Miles