Prostate cancer tests are now OK with panel, with caveats

by Noah Mcgee April 12, 2017, 3:25
Prostate cancer tests are now OK with panel, with caveats

The state report said screening "may be appropriate" for "patients who are black or have a positive family history of more than one family member with prostate cancer". He said PSA tests make sense if they do not lead to overly aggressive treatment.

"The decision about whether to be screened for prostate cancer should be an individual one", the U.S. Preventive Services Task Force said in a draft recommendation issued Tuesday. The task force says that of any 1,000 men offered the PSA test, that effort will possible save one man from dying from prostate cancer. That recommendation was based on evidence that PSA screening resulted in overdiagnosis and unnecessary treatment that could leave men impotent and incontinent.

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. "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 guideline is not final and remains open for public comment until May 8. But with more data on the subject, the task force now leans toward the benefits of screening. The task force argues that "many more men are expected to experience the harms of screening and treatment than will experience benefit". That's good news, because in the US, more men are opting for active surveillance.

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.

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The USPSTF graded the draft recommendation "C", which means it considers the net benefit of PSA testing small.

Most prostate cancers "are snails or slugs or tortoises", Hu said. Even more encouraging, the men who were screened had a 30% lower chance of developing metastatic prostate cancer if they did develop the disease. This spurs many men to opt for radiation and surgery right off the bat, which can cause urinary incontinence and impotence. If it's high, it could be because of cancer, or other things such as prostate enlargement or inflammation. 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. An elevated level can be due to cancer but also can reflect a benign condition such as an enlarged prostate. The American Cancer Society, for example, endorses "shared decision-making" in which men and their doctors discuss the pros and cons. Otis Brawley, chief medical officer of the cancer society, said the new task-force recommendation was an important step and "would decrease confusion".

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. 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.

The task force's initial recommendation generated political heat, and in 2015 Reps. Medicare and many private insurers have continued to pay for the screening.

The new guidance from the USPSTF is just a draft. 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.

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