An independent USA panel of experts has changed course on its recommendation against routine PSA screening of men for prostate cancer. "However, many men will experience potential harms of screening, including false-positive results that require additional workup, overdiagnosis and overtreatment, and treatment complications such as incontinence and impotence", the task force said in its recommendation. That's how we approach the subject of PSA testing at MSK. An elevated level can be due to cancer but also can reflect a benign condition such as an enlarged prostate.
The task force made a decision to adjust its screening recommendations based on new research.
"This isn't a one-size-fits-all" recommendation, said the panel's chair, Dr. Kirsten Bibbins-Domingo, a San Francisco internist who already follows the advice and discusses the potential pros and cons with her patients.
"The USPSTF recommends individualized decisionmaking 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 statement concludes.
What should patients keep in mind when they go to the doctor?
The harms include stressful false alarms that often to lead to painful and sometimes risky biopsies. For many men with prostate cancer, their disease will progress so slowly that they would not die from it if it were left untreated. Often, doctors and patients struggle to choose between active surveillance and treatments like surgery or radiation because it's hard to tell which tumors will grow fast enough to be life-threatening and which ones might never get big enough to cause problems. "It doesn't help us distinguish the types of cancers that are going to kill you from those cancers that are going to not progress over time and will not cause a man health problems".
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.
But the results of research from the last five years have changed that equation, the task force says.
According to Bibbins-Domingo, PSA screening can reduce the chances of dying from prostate cancer by catching it before it spreads to other parts of the body. The goal is to find cancer at an early, treatable stage. Instead, they and their doctors are opting for "watchful waiting" or active surveillance of the malignancy.
In a decision of concern to many middle-aged men and the doctors who care for them, the U.S. Preventive Services Task Force, or USPSTF, has changed its recommendation for prostate cancer screening specifically related to the blood test that measures prostate-specific antigen, or PSA, which can indicate a growing cancer.
Some patients such as African-Americans or those with family history of prostate cancer are at risk of developing aggressive disease at a younger age. That's the most important thing to me. "We now think, on balance, there is a small benefit".
"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. Those conversations should start at 55.
The Task Force is a government supported panel composed of national medical experts whose recommendations influence healthcare providers and both public and private insurance coverage decisions. "If this were to continue, we would lose all these gains in reducing the prostate cancer death rate".
The previous guideline, which was only a few years old, recommended against PSA testing in all age groups.
The new draft guidelines echo those of several leading medical groups.
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.
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