New Study Recommends PSA Screening for Prostate Cancer

Posted April 13, 2017

PCEC's council of experts believes that men should receive a baseline PSA blood test at age 40 to determine risk stratification, based on this assessment, PCEC recommends that men establish a testing follow up schedule with their doctor. Active surveillance has become a more common treatment choice for men with lower-risk prostate cancer over the past several years, and may reduce the chance of overtreatment.

"As a society, we have taken prostate cancer too lightly for far too long". This trial showed no benefit from screening but - thanks to data sharing - we know the trial wasn't flawless. Men with a family history of prostate cancer would also fall into this category.

The Task Force is an independent, government-supported volunteer group of experts from the nation in the field of prevention and evidence-based medicine. PSA-based screening and follow-up prostate biopsies can not tell for sure which cancers are likely to be aggressive and spread, and which will not-or will grow so slowly that they will never cause symptoms.

"The balance has shifted", she added, "and now we can recommend that men have a conversation with their doctors about screening".

The panel leaves open how often men should be screened. PSA screening isn't ideal and doesn't provide any information about other possible causes of death.

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Although screening for cancers of the breast, cervix, lung, colon and rectum must be fully covered by health plans, the panel's recommendations against routine PSA testing means that insurers may require co-payments to cover some of the cost.

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.

In the absence of that evidence, I would say that our recommendations definitely apply to these high-risk men. The significance of PSA testing is to establish such a contact between men and the healthcare system. For example, new data has shown that most prostate cancer cases grow slowly or do not grow at all.

Many men who have high PSA levels undergo a biopsy, which provides vital insight into whether a man has cancer but can't predict how aggressive it might be. "We need better tests", Bibbins-Domingo said. Instead, they should discuss the uncertainties about the test and order it only if their patients still want it, the panel said. If you treated everyone who was diagnosed with prostate cancer, which is what used to be done, most men would not benefit.

The PSA test measures the blood level of a naturally occurring protein secreted by the prostate. But, in the end, the most important thing for a given man is that he is aware that the science is telling us about benefits and harms, and that he uses that together to make the right decision for himself.

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The Task Force also recommends that clinicians talk with patients who have a family history of prostate cancer, particularly those with a father or brother diagnosed with prostate cancer, about their increased risk of developing the disease. But the results of a new survey, published in the journal JAMA Internal Medicine, suggests that most doctors are not heeding that advice. Prostate cancer screening may be OK for some men - those who are more tolerant of risk and uncertainty - but it is surely not right for others.

The task force updates their guidelines every five years.

According to Bibbins-Domingo, PSA screening can reduce the chances of dying from prostate cancer by catching it before it spreads to other parts of the body. And one or two would be kept from dying of prostate cancer over a 10- to 15-year period. "As the second leading cancer killer of men, it occupies a niche among diseases that closely parallel breast cancer among women both in terms of incidence and death rates in their respective populations", said Dr. Jean Bonhomme, a physician, board member of MHN, and founder of the National Black Men's Health Network.

"Prostate screening has been a contentious issue ever since the prostate specific antigen test became available more than three decades ago".

The task force's draft recommendation comes six months after it issued its findings in preliminary form. But first, they should have a talk with their doctor about the pros and the cons of the PSA test.

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