Published: Wed, April 12, 2017
Medical | By Garry George

What to know about new advice on prostate cancer test

What to know about new advice on prostate cancer test

The task force, a panel of experts supported by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality, on Tuesday is advising men between the ages of 55 and 69 to start a conversation with their doctors about whether to have a PSA test based on each patient's personal values and priorities.

The USPSTF did not change its recommendation against PSA-based screening for prostate cancer in men ages ≥70, finding that the potential benefits did not outweigh the potential harms.

The task force is an independent, volunteer panel of experts in prevention and evidence-based medicine that makes recommendations about preventive medical services, such as screenings, counseling services, and preventive medications.

However, other medical groups such as the American Cancer Society have been more nuanced, continuing to recommend regular PSA testing while urging patients and their physicians to discuss the benefits and risks. Specifically, the new evidence showed that screening PSA tests would prevent three cases of metastatic prostate cancer and one or two prostate cancer deaths.

The PSA test measures the blood level of a naturally occurring protein secreted by the prostate.

Yes, it acknowledges that African-American men and men with a family history of prostate cancer are at a higher risk for deadly prostate cancer.

In the study, only about 1 percent of men died of prostate cancer over 10 years, with no significant differences between those who were treated and those who simply kept a watchful eye.

"We have data now showing that active surveillance can save the same number of men from dying of prostate cancer; that there isn't an increased number of prostate cancer deaths with active surveillance compared with radiation or surgery", said Krist.

Of the other 100 men, in whom biopsy shows definite cancer, up to 50 have malignant cells that will turn out to be so slow-growing - "indolent" - that the cancer would never spread or harm them.

The draft recommendation will be open for public comments until May 8. These men would have psychological side effects: They'd worry about having prostate cancer when most wouldn't.

"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.

So, in its proposed revision, the task force drops its "D" recommendation against PSA testing for men ages 55 to 69 and replaces it with a "C" recommendation that each man in that age group make the decision about whether to get screened individually - in consultation with his doctor.

In addition, the task force noted, an increasing number of men with low-risk cancer are opting for "active surveillance", which involves regular PSA testing, repeated rectal examinations and biopsies rather than aggressive treatment.

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. At least 60 men suffer urinary incontinence and sexual impotence from the treatment.

Dr. Kirsten Bibbins-Domingo, a San Francisco internist believes "this isn't a one-size-fits all" procedure.

"Many men will have a high PSA at some point in their lives, and most of those will not be prostate cancer but that will be something that the patient and doctor will be anxious about" and will evaluate, Krist told ABC News. "This process demonstrates how the task force, specialists, patients, and the medical community as a whole can work together to develop recommendations that better reflect the clinical and research landscapes".

The D rating remains for men 70 and older.

The more you follow the studies that look at the benefits of PSA screening, the more positive they are becoming, he said.

A national organization committed to men's health, the Prostate Conditions Education Council (PCEC) is the nation's leading resource for information on prostate health.

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