Prostate cancer tests are now OK with U.S. panel, with caveats

Posted April 12, 2017

CHICAGO (AP) — An influential US government advisory panel is dropping its opposition to routine prostate cancer screening in favor of letting men decide for themselves after talking with their doctor. 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. New research shows testing men aged 55 to 69 may slightly reduce their chances of dying from prostate cancer.

In this photo taken Friday, April 7, 2017, Dr. Kirsten Bibbins-Domingo poses in her office in San Francisco. But the association expressed concern that, under the guidelines, men 70 and older would not be screened for prostate cancer. This is a complex decision. If it's high, it could be because of cancer, or other things such as prostate enlargement or inflammation. "That's why we recommended against screening". This is the strategy that the American Urological Association advocates: It's called shared decision-making.

But while some groups still recommend regular PSA tests, many have tempered their views. It recommends against testing men aged 70 and older.

"Because of the rising use of active surveillance, some are getting more years of life without side effects", said Bibbins-Domingo. "That's an antidote to overdiagnosis and overtreatment", he said. Their recommendations influence US government policy, primary care physicians and private insurers' coverage decisions. He is now a medical student at the Johns Hopkins School of Medicine.

"I do think you'll see a change with primary care doctors".

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Dr. Alex Krist, a member of the USPSTF task force and a family medicine doctor at Virginia Commonwealth University in Richmond, said a high PSA may not necessarily point to prostate cancer.

The recommendation applies to men who have not been diagnosed with prostate cancer and have no signs or symptoms of the disease, Bibbins-Domingo said. Several clinical studies demonstrated that the test helped find localized prostate cancer.

The PSA test, adopted widely beginning in the 1990s, detects the level of a protein, produced by the prostate gland, in a man's blood. The task force said that about 1 in 5 men who have their prostates removed suffer long-term problems with urinary incontinence that require pads. But many men can live with the disease for years without it causing serious illness. Some physicians say such a trend has already begun, but others disagree. "Guidelines are needed to ensure that all men have the opportunity to make an informed decision on whether or not to have a PSA test". Both had high PSA levels and were eventually diagnosed with prostate cancer. Eventually, as the test continued to show an increase, his doctor ordered an MRI, discovered a mass and did surgery.

The U.S. Preventive Services Task Force is a national independent volunteer panel of medical experts created in 1984. The panel made no special recommendations for these groups. A re-evaluation of the evidence is behind the update.

"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.

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The 2012 recommendation gave universal screening a D grade, meaning the potential benefits did not outweigh the harms.

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.

There are new recommendations regarding screening for prostate cancer. But first, they should have a talk with their doctor about the pros and the cons o.

Editor's note: Otis Brawley is chief medical officer of the American Cancer Society.

The guideline is not final and remains open for public comment until May 8.

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