Prostate cancer tests are now OK with panel, with caveats

Apr 12, 2017, 00:27
Prostate cancer tests are now OK with panel, with caveats

Both the U.S. Preventative Services Task Force and the Pennsylvania Prostate Cancer Task Force now advise men to talk with their doctors about whether they should be screened.

The Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.

"Prostate cancer is one of the most common cancers to affect men, and the decision about whether to begin screening using PSA-based testing is complex", Dr. Alex H. Krist, a member of the task force and associate professor of family medicine and population health at Virginia Commonwealth University, said in a statement.

"There is a close balance of benefits and harms", Krist said, "and that's why it's important for men to be involved in making the decision of whether screening is right for them". Medicaid and many insurers cover PSA screening. That recommendation was based on evidence that PSA screening resulted in overdiagnosis and unnecessary treatment that could leave men impotent and incontinent.

"Risk stratification and personalized medicine should be a key component of early detection", stated Wendy Poage, President of PCEC, "We have stressed the importance of prostate cancer markers in identifying men who should be biopsied and treated and developed an online tool to help patients understand these tests".

The USPSTF's new recommendation points to the need to prioritize research on high-risk groups like African-Americans and those with a family history of the disease, as well as continue to demonstrate the effectiveness of diagnostic tools to determine aggressive disease. But PSA levels can be elevated because of other benign conditions, such as an enlarged prostate or an inflammation of the prostate. While many prostate cancers cause no problems, men may opt for radiation or surgery, which can cause sexual impotence and/or bowel and bladder problems. "Some men will want to avoid the chance of dying of prostate cancer no matter what, while others, given the side effects, will not think the benefits are worth it". The potential harms of screening include frequent false-positive results, which can result in immediate, additional testing, and years of additional close monitoring with repeated blood tests and biopsies. The latest research also suggests a small net benefit from screening, she says.

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The draft recommendation and evidence reviews are posted for public comment for consideration in the final recommendation and evidence review. "So many men today are being diagnosed with later stage prostate cancer because they were not regularly screened".

"We've been jumping up and down about this for years and years", Dr. Benjamin Davies, an associate professor of urology at the University of Pittsburgh School of Medicine, told CNBC.

Prostate cancer is one of the most common types among men in the USA; almost 13 percent will be diagnosed with it over the course of their lifetimes, according to the National Cancer Institute. Those 70 and older shouldn't get screened.

But other doctors fear the task force's recommendation will be oversimplified into a recommendation for screening. Further, the USPSTF recognizes that research is underway to develop diagnostic tools for prostate cancer.

That brings federal guidelines in step with recommendations from a state task force, released last week. More studies on the potential benefits vs. harms of screening for prostate cancer are needed among men with a family history of prostate cancer. The recommendations say nothing about men under 55, for whom some groups do recommend screening in some circumstances.