What should men do in prostate cancer screening?
For years, men have been asked to get a blood test that looks for prostate-specific antigen (PSA), which can be raised by prostate cancer. Then, in 2012, the United States Preventative Services Task Force (USPSTF), a government-sponsored but independent network of national experts in disease prevention and evidence-based medicine, said that PSA testing did more harm than good. They stopped recommending it at all.
Now, the same group has finalized the 2012 screening guidelines. Instead of completely bypassing PSA, men between the ages of 55 and 69 should talk with their doctor about the risks and benefits before making their own decision on whether to screen them or not.
The Taskforce says the change was driven primarily by a 201
The European study showed that one prostate cancer was harmed by screening for every 1000 men examined between the ages of 55 and 69 years. Screening also prevented the spread of three prostate cancer cases in four of the seven countries in the European study. 1,000 men are screened.
Dr. Alex Krist, Deputy Chairman of the USPSTF and Professor of Family Medicine and Population Health at Virginia Commonwealth University, says that the "extended follow-up of 10 years in these trials, which was unavailable in 2012, has contributed greatly to the decision.
The extended follow-up showed that some men's lives would be saved if they chose between 55 and 69 years of age. It is noteworthy that the committee still considers the screening as inappropriate for men over the age of 70 still suggests more harm than good in this age group.
The committee noted research on some populations that may be at higher risk for prostate cancer and death. The incidence is 74 percent higher in African Americans than in whites. A family history of prostate cancer is also a known risk factor for the development of the disease.
Prostate cancer is the most commonly diagnosed cancer in men and the second most common cause of cancer death in the United States. By 2018, an estimated 165,000 men will be diagnosed and 29,000 will die from prostate cancer.
The controversy over prostate cancer screening has developed because of the blood test in the late 1980s, looking for PSA.
PSA can be elevated when prostate cancer is present, but it can also be elevated for a number of other reasons – inflammation or infection – that cause many false positives.
The men screened in the European study that pushed the rule changes had a false positive rate of 17.8 percent. The problem with false positives is that a patient must undergo a biopsy to confirm prostate cancer.
Biopsies have side effects such as pain, infection and bleeding. Even if cancer is present, 20-50 percent of prostate cancers never grow, spread or damage the patient, but doctors can not say which of them are harmful and which are harmless. The treatment also has side effects, and evidence shows that every fifth man undergoing prostate surgery has long-term urinary incontinence and two out of three men will have long-term erectile dysfunction.
According to Krist, the general message of the USPSTF is that they recognize that this is a complex decision.
There is no "right answer," he said.
We know that some men will benefit from the screening. We know that many men will suffer screening damage. It depends on what these men appreciate and talking to their doctor is an important process if the screening is right for them.
The USPSTF recognizes that these recommendations can be confusing for both patients and medical providers. Therefore, they have set up a user-friendly website for those who want to learn about prostate cancer and the new recommendations: https://screeningforprostatecancer.org/
David J. Kim, MD is a last year Emergency Medicine resident at the University of California, Los Angeles, working with the ABC News Medical Unit in New York.