What to know about new advice on prostate cancer test

Posted April 13, 2017

"[I'm] pleased that the new recommendation is evidence based-first from the ERSPC [European Randomized Study of Screening for Prostate Cancer], a study that shows that screened men are about 30% less likely to die of prostate cancer and 35% less likely to get metastatic disease, and data showing the use of active surveillance is growing", Eric A. Klein, MD, chair of the Glickman Urological & Kidney Institute at Cleveland Clinic, said in an interview with OncLive.

While PSA tests can detect prostate tumors at their smallest, most treatable stage, the testing has some risks, (Dr. Kristen Bibbins-Domingo, a professor of medicine at the University of California San Francisco) says. The PCEC is dedicated to saving lives through awareness and the education of men, the women in their lives, as well as the medical community about prostate cancer prevalence, the importance of new marker utilization, and available treatment options, as well as other men's health issues.

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However, the latest updated guideline gives every patient (between 55 and 69 years old and with no symptoms or history of prostate cancer) the opportunity to decide whether they want regular screenings or not.

The Preventive Services Task Force is changing recommendations that can affect millions of middle-aged men.

PSA screening to detect the most common male cancer is among the most heated topics in men's health.

However, in that same group, 235 men will be recommended for a biopsy, which can cause infection, bleeding and pain.

Based on longer follow-up of studies, "the task force is backing off from, 'Do not screen, ' to 'Let's talk about it, ' and then, I would say, in time, it will probably come to, 'We think you should do it, '" he said.

The task force's recommendations influence USA government policy and are widely followed by primary care physicians. The Council - comprised of a consortium of leading physicians, health educators, scientists and prostate cancer advocates. "Once you find it, it tends to grow slowly".

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. "We need better tests", Bibbins-Domingo said. The group continues to recommend against PSA testing for men 70 and older because the harm can outweigh any benefits.

"That only about a third of patients [in the study] reported having a discussion of advantages and disadvantages is an alarming statistic", study author Dr. George Turini III said in a news release from the Rhode Island university.

The PSA test measures the level of a protein that, when elevated, can mean prostate cancer is present. Some clinical research suggests strongly that more prostate cancer deaths could be averted if physicians used PSA thresholds that were lower than those widely used in the United States to diagnose prostate cancer. That applies to men aged 55 to 69 of average risk for prostate cancer as well as those with higher odds, including blacks and men with a family history of the disease.

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. Because of this reason, many false-positive results could alarm patients unnecessarily, said Dr. Otis Brawley, chief medical officer of the American Cancer Society.

"MHN believes all men should speak to their healthcare provider about a baseline prostate cancer screening at age 40, earlier if they wish, and consult with their health care provider about screenings beyond that age", Fadich said.

Men whose greatest concern is reducing their chances of dying from cancer are sometimes willing to face the consequences and choose testing.

While these benefits may take 10 years or more to see, the harms from screening and treatment are immediate, she noted.

"What I'm afraid of is that rather than having this discussion - because it's a hard and long discussion - physicians will just order this test like they do ... a cholesterol panel", Merenstein says.

The task force's draft recommendation comes six months after it issued its findings in preliminary form.