Experts Divided Over New Prostate Cancer Screening Recommendations

7 2017 Dr. Kirsten Bibbins Domingo poses in her office in San Francisco. Draft recommendations from the US Preventive Services Task Force ditch the old advice against PSA screening and say

7 2017 Dr. Kirsten Bibbins Domingo poses in her office in San Francisco. Draft recommendations from the US Preventive Services Task Force ditch the old advice against PSA screening and say

Now based on the latest research, the group has reversed its recommendation, and now says men 55 to 69 should have a conversation with their doctor and make a decision for themselves.

"Five years ago, the task force discouraged men of all ages from a PSA test because of concerns about the limited value of screening and potential overtreatment when cancer was detected", said Kane.

A common blood test checks for elevated levels of prostate-specific antigens (PSA) in a man's blood, as an indicator that he may have prostate cancer. Even so, it said, the balance between pluses and minuses is very close, and it advised men from 55 to 69 that they should consult their doctors in deciding whether to get the PSA.

The new guidelines bring the task force more in line with other groups - such as the American Urologic Association, the American College of Physicians, and the American Cancer Society - which have still encouraged patients and doctors to discuss the test. "The AUA commends the USPSTF for its decision to upgrade its recommendation for prostate cancer screening", AUA President Richard K. Babayan, MD, said in a statement. And that's why we really emphasize that these discussions are important ones to be had between doctors and patients to really understand, for any given man, what is the right choice for him?

According to the task force, one of the studies helped them on the making of the new guideline was published back in last year's October.

The trouble, as the task force notes in its new guidelines, is that even these patients with added risk don't have solid proof that PSA tests will help them.

Prostate cancer affects 101.6 out of every 100,000 men in the United States, according to the Centers for Disease Control and Prevention.

"The most vulnerable men are getting less counseling", said study co-author Annie Gjelsvik, an assistant professor of epidemiology at Brown's School of Public Health.

The American Urological Association is hailing the proposed new recommendation as "thoughtful and reasonable".

And if someone has a slow-growing prostate cancer that doesn't necessarily need treatment, the emotional distress of a cancer diagnosis shouldn't be underestimated, Turini said. Another option of dealing with prostate cancer is active surveillance, which essentially means monitoring tumor growth rates to see whether they become alarming or not.

"We need to at least make an educated decision with our patients, and to do that we need to have that discussion about PSAs", Thrasher said.

Nor did the panel offer advice to men with a family history of the disease, who are about 30 percent more likely to be diagnosed than men with no first-degree relatives who had it. For example, new data has shown that most prostate cancer cases grow slowly or do not grow at all.

"After a lot of testing, they were able to figure out not only did I have prostate cancer, but it had already spread to other parts of my body", Taylor said. High levels of this protein could indicate the presence of prostate cancer, the Mayo Clinic says, or other conditions like an inflamed or enlarged prostate.

However, Brawley emphasized an issue that has often gotten lost in the controversy about when and how to begin PSA-based screening for prostate cancer. Bibbins-Domingo said that the final draft may come toward the end of the year, once the task force considers all the public comments it receives. Preventive screenings rated A or B by the Task Force are covered by the Affordable Care Act. But the results could lead to biopsies, radiation, or surgery that carry risks including impotence, bladder and bowel problems. Men who were diagnosed with prostate cancer were rushed to treatment with surgery, radiation or hormones. The task force says the increasing use of watchful waiting is helping to spare more men the side effects of over-aggressive treatment.

PSA screening, then, is like a dentist applying a sealant to one of your 32 teeth, and that sealant reduces the risk of losing the treated tooth by 20 percent. After following patients for a longer period of time, it was shown that for every 1,000 men screened, one to two lives were saved.

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