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


A few years ago, experts said the test was doing men more harm than good and advised doctors to not do it.

The potential benefit is reducing the chance of dying of prostate cancer, though that chance is small. Many more men are expected to experience the harms of screening and treatment than will experience benefit.

For decades, prostate cancer screening was a routine part of health care for men of a certain age.

But not everyone with prostate cancer benefits from treatment. For example, new data has shown that most prostate cancer cases grow slowly or do not grow at all. Ultimately the goal of the PSA test is to identify cancer earlier on before it becomes terminal.

The Task Force is an independent, government-supported volunteer group of experts from the nation in the field of prevention and evidence-based medicine. There is a big difference between the phrase "reduces the risk of dying from prostate cancer" and the phrase "reduces the risk of dying". Previously, in the 2012 opinion, the task force had also recommended against the test for the 55-to-69 age group, saying the possibility it lowered deaths from prostate cancer was "very small". Now, people 70 or older who have not shown any signs of the disease are no longer discouraged from undergoing regular screenings and check their PSA levels.

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. He's had some side effects, but says they are getting better.

The statement serves to guide clinicians and patients in decision making about screening for prostate cancer. His research suggests that more than one in five men worldwide have undetected prostate cancer, including more than 40 million Americans, but that most will die of other causes. 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.

"They should be aware that the PSA test is a screening test for prostate cancer, it might have a false elevation but it's the only test we have that's blood-based that can detect prostate cancer clearly", said Brandt. "The newer recommendation should empower men to be proactive about learning about the benefits and risks of screening and not avoid asking about it because their personal physician is not a believer in screening and never even broaches the subject; men should ask for the facts and not be shy about asking to have a PSA ordered if they feel it's in their interest to do so". After the comment period ends, the task force will consider the input and come up with its final recommendation in the following months.

But screening for prostate cancer is fraught with uncertainty, and even a diagnosis usually raises more questions than it answers.

The draft recommendation will be open for public comments until May 8.

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DR. KIRSTEN BIBBINS-DOMINGO: Well, I think the most important thing to say is that there are benefits and there are harms, and what that balance looks like for any given man depends on how he values those benefits and harms. The draft recommendation applies to men at average risk and men who are at increased risk for prostate cancer, such as African American men and men with a family history of prostate cancer. Those 70 and older shouldn't get screened.

"It sounds like cooler heads have prevailed", said Dr. Jim Hu, a urologist and prostate cancer specialist at New York-Presbyterian/Weill Cornell Medical Center who called the old advice "draconian".

Dr. Herbert Lepor says advances in detection and closely monitoring low risk cancers are helping men avoid drastic treatment. High levels on it-while possibly indicative of prostate cancer-more commonly signal something way less serious, like an enlarged prostate or a prostate infection.

Of those 240, biopsies would find that only 100 have prostate cancer. The U.S. Food and Drug Administration approved the test for screening in 1994.

The stance marks a reversal from the panel's recommendation in 2012, when it concluded that the adverse effects of the blood test outweighed its benefits.

The group still has the same concerns about false positives and unnecessary treatment that it had in 2012. Some of the harms associated with treatment may include sexual impotence and urinary incontinence.

If you're a man between ages 55 to 69, one aspect of your medical care may have just gotten a little more confusing.

Blumberg needed surgery to remove his prostate.

Q: What is the task force? The task force's recommendations influence US government policy and are widely followed by primary care physicians. "That's why we recommended against screening".

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