Prostate cancer tests are now OK with panel, with caveats

Those older than 70 shouldn’t undergo PSA screening, the task force said.

As an oncologist who cares for cancer patients, I have no desire to trivialize cancer, and I know that prostate cancer is far worse than losing a tooth.

“For me, it’s personally very important because there’s absolutely no reason in my mind why people shouldn’t be getting a PSA test, especially if they have a family history”, Taylor said.

Men’s Health Network (MHN) is encouraged by the latest recommendations from the U.S. Preventative Services Task Force (USPSTF) that urges men to talk to their healthcare providers about when, or if, they need to be screened for prostate cancer. The latest data show that over 180,000 men were diagnosed with prostate cancer in 2016, but there were only 26,000 deaths from it. Prostate cancer accounted for 4.4 percent of all cancer deaths in the United States past year.

He says he supports the new recommendations, but not the part that lowers the outside age for screening from 75 to 70.

The draft recommendation that the screening holds some potential benefit for men 55 to 69 is a reversal of the USPSTF 2012 controversial recommendations against the screening. 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.

In 2012, 63 percent of men underwent PSA tests. This is leading more and more to professional guidelines that respect patient preference and put the screening decision in the hands of the patient.

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. There is a big difference between the phrase “reduces the risk of dying from prostate cancer” and the phrase “reduces the risk of dying”.

Men diagnosed with lower-risk prostate cancer are monitored with more frequent PSA testing and prostate biopsy rather than immediate surgery or radiation.

New laser therapy can effectively kill prostate cancer cells. The results led to unneeded biopsies, radiation, or surgeries that had life-altering side effects.

For these men, the task force recommends withholding treatment and monitoring the cancer until it requires treatment.

PSA-based screening tests for a protein in the blood that is produced by the prostate gland.

If as many as half of prostate cancer diagnoses are cases of over-diagnosis, that makes the question of who should be screened – as well as how often and at what level of sensitivity – a consequential one.

Dr. David Penson, a urologist at Vanderbilt-Ingram Cancer Center, agrees with the task force’s decision.

Christopher Kane, MD, chair of the Department of Urology at UC San Diego Health, is an internationally recognized prostate cancer specialist and researcher. Most men are diagnosed after age 60.

The panel says its new advice stems from long-term research indicating that for every 1,000 men offered PSA screening, one to two will avoid death from prostate cancer and three will avoid prostate cancer spreading to other organs. However, this type of cancer is not the only thing that can generate a PSA rise, since several infections or even a benign enlargement of the prostate could do it. The panel made no special recommendations for these groups. We want to test the right men at the right time, following an appropriate discussion about risks and benefits.

A 2015 study concluded that avoiding treatment of low-grade prostate cancer in Americans who would never die from the disease would save $1.32 billion per year.

Two years later, a survey of more than 111,000 men found little change – only 30 percent reported discussing both the pros and cons of PSA testing.

Some of those critics asserted that screening should be credited for a decline in US deaths because of prostate cancer mortality over the last two decades.

Dr. Dan Merenstein, a family medicine physician at Georgetown University, doesn’t think the new evidence warrants a change.