Prostate cancer tests are now OK with US panel, with caveats

Prostate cancer tests are now OK with US panel, with caveats
Prostate cancer tests are now OK with US panel, with caveats
Author

12 April, 2017

The changes? The harms and benefits of PSA testing for men ages 55 to 69 is closely balanced-so the choice to screen for prostate cancer should be an individual one that men in this age group make together with their doctor, the recommendations state.

In 2012, the U.S. Preventive Services Task Force recommended that men no longer get their PSA tested. "Patients should have a discussion with their primary care physicians about the pros and cons of screening". The task force said new data show that PSA screening in the younger group prevents 1 to 2 deaths from prostate cancer over 13 years per 1,000 men screened. The latest research also suggests a small net benefit from screening, she says. For many men with prostate cancer, their disease will progress so slowly that they would not die from it if it were left untreated.

The blood test isn't a diagnosis of cancer and it isn't good at detecting whether high levels of protein-specific antigens - a substance made by both good cells and cancer cells in the prostate - indicate cancer or are harmless. Some cancers, ironically the ones easiest to diagnose and cure, are so slow-growing they are of no threat to the patient: They do not need to be cured, as they would never do harm if left alone. However, doctors can't tell the sluggish cancers from the killer ones. Treatment often involves radiation or surgery, which can cause incontinence and impotence.

Should middle-aged men get routine blood tests for prostate cancer?

Bibbins-Domingo said that several studies have reinforced not only the benefits of PSA tests but also ways to lessen the harms of screening, which include unnecessary biopsies and treatments.

Jim Hu, a urologic oncologist at Weill Cornell Medicine and New York-Presbyterian, praised the recommendation reversal. The biggest remaining difference is timing.

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Why that age range: 55 to 69?

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. This is an improvement over the previous "D" recommendation issued by the task force in 2012, which advised against all PSA screening. "Every man should be given the opportunity to consider screening, especially those at higher than average risk owing to race, family history, or other factors".

Dr. Meir Stampfer, a Harvard University cancer expert, called the new advice "a more reasoned approach".

"The PSA test is not a great test", Bibbins-Domingo says. The task force says the median age of death is 80. Since then, PSA screening rates have declined by as much as 10 percent, and now fewer than one-third of US men get the tests. But with no effective way to tell the unsafe prostate cancers from the harmless ones, most men undergo surgery or radiation after diagnosis.

The new recommendation is a reversal from the one they issued in 2012, when the USPSTF advised most men not to get screened for prostate cancer using an low-cost blood test, called a prostate specific antigen (PSA) test. Their recommendations influence USA government policy, primary care physicians and private insurers' coverage decisions.

While these benefits may take 10 years or more to see, the harms from screening and treatment are immediate, she noted.

Responding to the draft recommendation, Richard K. Babayan, MD, president of the American Urological Association (AUA) stated: "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 - including the American Cancer Society, the American College of Physicians, the American Society of Clinical Oncology and the National Comprehensive Cancer Network, all of which advocate for shared decision making".


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