Experts Propose Changes To Prostate Cancer Screening Guidelines

Judith QuinnApr 12, 2017

An independent US panel of experts has changed course on its recommendation against routine PSA screening of men for prostate cancer. The task force recommends that doctors have a conversation with their male patients who don't have signs or symptoms of the disease about the benefits and drawbacks of taking the prostate-specific antigen blood test.

So why the controversy? Because the test is imperfect, Brawley said, there are a number of missed cancers and false alarms.

The draft of the guidelines signals a major shift in prostate screening advice for men, which in 2012 discouraged testing for healthy men of any age. She is a chair in medicine and a professor of medicine, epidemiology and biostatistics at the University of California, San Francisco. "With active discussions between physicians and patients, individuals will be able to make the right decision for themselves". But first, they should have a talk with their doctor about the pros and the cons of the PSA test. 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.

In a grade D recommendation, the USPSTF continued to discourage PSA screening in men aged 70 and older.

"Given that most prostate cancers are slow growing, and given the risks of over-diagnosis and over-treatment, there is little evidence that men 70 and older benefit from PSA screening", said Dr. Quoc-Dien Trinh of the Brigham and Women's Hospital and Dana-Farber Cancer Institute Prostate Cancer Program in Boston. Other groups say start earlier, depending on family history of prostate cancer and other factors.

The revised draft recommendation is open to public comment before a final recommendation is issued. Men with prostate cancer may be candidates for surgery or radiation. The test comes with many potential problems but brings the benefit of ever so slightly reducing the chance of dying from the cancer.

Instead of treatment, many men with low-risk prostate cancer can opt for active surveillance, which may reduce the chance of overtreatment.

In the study, only about 1 percent of men died of prostate cancer over 10 years, with no significant differences between those who were treated and those who simply kept a watchful eye. "The right decision isn't screening all men, it's making all men aware of the benefits and harms, and then allowing each man to make the best decision for himself", Bibbins-Domingo explained. Patients should keep in mind that black men and those with a family history of prostate cancer are at greater risk, while also considering that PSA tests may lead to unnecessary procedures that have side effects like impotence and incontinence. The task force is charged with making "evidence-based" recommendations about clinical preventive services, including health screenings, counseling services and preventive medications. 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. It may also delay treatment and its complications, or avoid treatment completely, Bibbins-Domingo said.

Krist said the uncertainty at every step of the way in diagnosing and treating prostate cancer makes it crucial for men to discuss the options, and their concerns, with their doctors. However, Meigs said that he and other family doctors have come to depend on the task force's recommendations, which are known for sticking closely to the available evidence.

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

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