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

WASHINGTON D.C. (WPVI) -- The Preventive Services Task Force is changing recommendations that can affect millions of middle-aged men.

Five years ago, it opposed routine screening for prostate cancer, saying the potential harm outweighs the benefits.

Now it favors letting men decide for themselves after talking with their doctor.

The new draft guidelines released Tuesday 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 has a small chance of detecting a deadly cancer and a larger chance of triggering unneeded worry and treatment with serious side effects.

Read the new advice here.

But now, the group says men between the ages of 55 and 69 should discuss screening with their doctors, to decide if the PSA blood test is right for them and how often they should be checked.

The task force says the increasing use of watchful waiting is helping to spare more men the side effects of over-aggressive treatment.

PSA screening is among the most heated topics in men's health.

It can signal cancer but also can be caused by less serious prostate problems.

It can find cancer that frequently doesn't need treatment because it's too small and slow growing to become deadly.

Doctors say there's no good way to tell which early cancers might become lethal. The next step is often radiation or surgery to remove the prostate, which may result in impotence and incontinence.

The shift shelves the panel's 2012 guidance, which prompted criticism from some urologists - specialists who treat the disease - and angered some prostate cancer patients certain that PSA screening had saved their lives.

Men whose greatest concern is reducing their chances of dying from cancer are sometimes willing to face the consequences and choose testing. "Other men will realize the likely benefit is small and aren't willing to risk the harms," she said.
"This isn't a one-size-fits-all" recommendation, said the panel's chair Dr. Kirsten Bibbins-Domingo, a San Francisco internist.

"The rates from the trials of prostate cancer screening suggest that about 20 to 50 per cent of these are overdiagnosed - that is, that they are prostate cancer, but of the type that are slow-growing, and not likely to cause a problem," Bibbins-Domingo told Action News.

The new recommendations come from the U.S. Preventive Services Task Force, a government-appointed volunteer panel of experts. The group says the change is based on new evidence indicating that routine PSA blood tests can slightly reduce some men's chances of dying from prostate cancer and that drastic treatment can sometimes be avoided with close monitoring when cancer is detected.

The new advice published Tuesday closely aligns the panel with medical groups that also support shared decision-making.

The biggest remaining difference is timing.

The task force draft says screening conversations should begin at age 55.

Other groups say start earlier, depending on family history of prostate cancer and other factors. It recommends against testing men aged 70 and older.

The panel leaves open how often men should be screened.

And it said it couldn't make specific recommendations for African-American men, who have the highest risk of prostate cancer.

But it does say they should know their risks are higher.

The task force's 2012 advice against screening said there was little evidence that PSA screening was reducing deaths. Since then, PSA screening rates have declined by as much as 10 percent, and now fewer than one-third of U.S. men get the tests.
Fewer men are being diagnosed with early-stage disease, when it is more treatable, while more are being diagnosed with more aggressive harder-to-treat cancer.

"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. Meir Stampfer, a Harvard University cancer expert, called the new advice "a more reasoned approach."

He said PSA tests make sense if they do not lead to overly aggressive treatment.

His research suggests that more than 1 in 5 men worldwide have undetected prostate cancer, including more than 40 million Americans, but that most will die of other causes.

Newer research also has shown benefits from "active surveillance" of men whose initial PSA tests and biopsies indicate slow-growing cancer that hasn't spread, the panel said.

The task force's recommendations influence U.S. government policy and are widely followed by primary care physicians.

Medicare and many private insurers have continued to pay for the screening. The panel reviews evidence and issues advice for a variety of screenings and treatments.

The draft prostate cancer recommendations, announced online in the Journal of the American Medical Association, are open for public comment on the task force website until May 8.

And it called for more research on a better version, or a replacement for the P-S-A test.


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