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USPSTF Drafts Prostate CA Screening Recommendations


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 cheap blood test, called a prostate specific antigen (PSA) test.

Prostate screening has been a contentious issue ever since the prostate specific antigen, or PSA, test became available some 30 years ago.

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 US Preventive Services Task Force now suggests decisions about PSA testing should be made on an individual basis for men aged 55 to 69. PSA screening may reduce the number of deaths, but it may also lead to false-positive results, unnecessary biopsies, overdiagnoses, and treatment complications, such as incontinence and erectile dysfunction.

The new draft guidelines echo those of several leading medical groups, but they don't make the decision any easier for men: With their doctor's help, they have to decide whether to take an imperfect PSA test that carries a small chance of detecting a deadly cancer and a larger chance of triggering unneeded worry and treatment with serious side effects.

There's no changes to the recommendations for older guys: The task force still recommends against PSA screening for men 70 and older. 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.

Nearly 240,000 new cases of prostate cancer are diagnosed each year. The task force says the median age of death is 80. The American Cancer Society says start PSA discussions at age 50 for men at average risk; at age 40 for men with a strong family history and age 45 for black men.

But the PSA test offers a small potential for benefit - with clear potential for harm. That's good news, because in the USA, more men are opting for active surveillance.

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The prostate draft recommendation notes that the decision "to be screened for prostate cancer should be an individual one".

"We remain particularly concerned about the striking absence of evidence to guide these high-risk men specifically as they make decisions about screening", she said. 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.

The statement serves to guide clinicians and patients in decision making about screening for prostate cancer. "And having the U.S. Preventive Services Task Force discourage PSA screening has sort of created a whole generation of family practitioners and internists who feel that PSA screening is a bad thing to do for patients". An elevated level can be due to cancer but also can reflect a benign condition such as an enlarged prostate.

Because primary care physicians who do the majority of PSA testing cut back on the practice after the task force advised against it, the new guidelines may lead more men to get screened, said Dr. John Davis, a urology researcher at the University of Texas MD Anderson Cancer Center in Houston who wasn't involved in the recommendations. The advice would bring the influential panel more in line with other major doctor groups.

"There are some men who might say, 'You know, I really want to avoid dying of prostate cancer".

"Screening programs may also prevent up to 3 cases of metastatic prostate cancer per 1,000 men screened over 13 years", the statement says.

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. Medicare and many private insurers have continued to pay for the screening.

"The PSA test is not a great test".

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