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A yellow light but little instruction on PSA testing



. 8 May 2018 – Should you get a PSA test for prostate cancer? In 2012, an influential group of doctors giving recommendations for preventive treatment answered this question with a firm "no".

That's because studies have shown that these can damage blood tests – including misleading results, infections, anxiety and aggressiveness. Treating cancers that would never have harmed a human being if they had gone undetected seemed to outweigh the potential benefits ,

Today, this group, the US Task Force Prevention, has officially relaxed its stance. Prostate cancer screening tests say it makes sense for some men between the ages of 55 and 69, including those at above-average risk due to a family history of prostate or related cancers, or because they are African-American.

Researchers have also noticed more cases of aggressive prostate cancer since the 201

2 standards were released.

The working group says that these men should undergo PSA testing only after a detailed discussion of the pros (19659002) The PSA is a blood test that measures a protein that is formed by the prostate gland, a small gland sitting directly under the bladder and producing seminal fluid. Prostate cancer makes more of this protein.

The problem is that many men never have this important speech, which is part of a process known in medicine as shared decision-making.

A 2018 American Cancer Society study found that only about 17% of men who had recently been tested in a PSA test had done so after a full discussion with their doctor. The same study found that about 38% of men did not receive any information from their doctor before the test. When doctors talked to patients, they often spoke with glowing words, extolling the benefits of the test but not its risks.

"I do not think most doctors have the data at hand to sit down and advise a man on how many men need to be overdiagnosed with prostate cancer to prevent just one death," says Therese Bevers MD, medical director of the Cancer Prevention Center at the MD Anderson Cancer Center in Houston.

Dangers of oversupply

Overdiagnosis means that the test and a follow-up biopsy will find a non-aggressive cancer that is unlikely to grow or spread. Overdiagnosis can lead to over-treatment, which in turn can cause life-altering complications such as incontinence and impotence.

The Task Force has estimated that among 1,000 men who receive a PSA test, between 20 and 50 men will be overdiagnosed for every one to two deaths that are prevented.

"It's really difficult for patients and providers to understand the evidence," says Ruth Etzioni, PhD, of the Fred Hutchinson Cancer Research Center, which examines the pros and cons of PSA testing.

Etzioni says that she is pleased The Task Force has repealed its blanket statement that PSA testing is unjustified. But she wished the panel had given the men and their doctors more information about implementing the guidelines to help them, which could be a difficult decision.

"It's a bit of a can to step down the street just to say," You guys do it. We can not tell you whether we should or should not do it, "says Etzioni.

The Task Force provides a graphic and patient-friendly explanation for its new recommendation.

Managed Care Fights

Still Some experts say That these materials will not be enough.

"I do not think the resources are out there, which is really unfortunate," says Otis Brawley, MD, medical and scientific director of the American Cancer Society.

Brawley is pleased too The task force is now recommending a decision on PSA testing to their middle-aged physicians to make their recommendations in line with the American Urological Association and the American Cancer Society.

But he also says he does not hope so that more patients would get a PSA test with a full understanding of its risks.

"Doctors are not really paid to deal with patients Echen. If you are in primary care, the clock will start as soon as you enter the room. You have to deal with all the problems of this patient and get in and out in 15 minutes, "says Brawley.

" There are so many things on a family internship that they really do not take the time to make informed decisions

A Very Rare Diagnosis

So what should you know if you're considering PSA testing?

"The first thing you should know when they're in their fifties Years, is that it is a very rare diagnosis, "says Etzioni.

Only 2% of men, or 1 in 50, are diagnosed with prostate cancer by the National Cancer Institute in the '50s, about 6% of men, or 1 in 16 are diagnosed in the 60s.

The risks of fatal prostate cancer are higher for men who have parents, brothers, or sisters diagnosed with certain types of aggressive cancers called adenocarcinomas Cancer of the prostate, breast (male or female), ovary or pancreas, especially when this relative got cancer at a young age and spread rapidly.

Because of this, the Task Force recommends that men talk about family history with their doctor about PSA testing.

African Americans face higher risks

Prostate cancer is more common in African American males. It is also deadlier. For these reasons, the Task Force, the American Cancer Society, and the American Urological Association say that African-American men can benefit from regular PSA testing from the age of 55 after talking to their doctors.

While the potential benefits of testing are small, they are most significant for men who are younger and otherwise healthy.

Physicians should not test men who already manage many other health conditions such as heart disease, obesity or diabetes, says H. Ballentine Carter, MD, a surgeon and prostate cancer researcher at Johns Hopkins University. "They have larger fish for frying," says Carter.

Prostate cancer would not be their most urgent health problem or the one that would most likely shorten their lives or their quality of life.

"We all need to prioritize what we need to do to improve our health, which may not be high on the list," says Etzioni.

You should also consider how willing you might be to get treatment. If you do not want to risk complications such as bowel problems, erectile dysfunction or incontinence, the task force says that you should not receive a PSA test. Likewise, they say that most men over the age of 70 or older should not be tested the risks still outweigh potential benefits for them.

"Watchful Waiting" Preferred

While over-diagnosis of prostate cancer is still a problem, over-treatment has become less likely because doctors feel more alert with a treatment strategy called the "well-being". That means you see your doctor regularly to keep an eye on the cancer, but do not treat it.

"What has happened now is that in the last 5 to 7 years we have been better at identifying the men, I need a treatment compared to the men who need treatment," says Brawley. "Most men who are diagnosed with prostate cancer are being watched and not treated, which is a big change."

Even if you decide to skip the PSA test, the Prostate Cancer Foundation says that you have a doctor should visit if you have any symptoms of prostate problems, including:

  • especially at night
  • Problems starting or stopping urine
  • Weak, dribbling or interrupted urinary stream
  • Pain or burning while peeing
  • Difficulty building an erection
  • Descent of the semen
  • Pain when you ejaculate
  • Blood in your urine or semen
  • Pressure or pain in your rectum
  • Pain or stiffness in your lower back, hip, pelvis or Thighs

Sources

Therese Bevers, MD, Professor, Clinical Cancer Prevention, MD Anderson Cancer Center, Houston [19659054] Ruth Etzioni, PhD, biostatist, Fred Hutchinson Cancer Research Center, Seattle

Otis Brawley, MD, Senior Medical and Scientific Officer, American Cancer Society, Atlanta.

H. Ballentine Carter, MD, surgeon and prostate cancer researcher, Johns Hopkins University, Baltimore.

Annals of Family Medicine March / April 2018.

Journal of the American Medical Association 8. May 2018.

CDC: "Prostate cancer risk by age".


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