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

Posted April 13, 2017

It is not recommended that men ages 70 and up, including African American men and men with a family history of prostate cancer, undergo screening for prostate cancer.

Urology Chairman at NYU Langone Medical Center Dr. Herbert Lepor says advances in detection, treatment, and monitoring are helping men avoid over-treatment.

Bibbins-Domingo said the revised position on prostate-cancer screening wasn't due to political pressure but reflects the updated evidence on the balance of benefits versus harms. "In many cases, these groups may not access the healthcare system and have dialogue with their medical professionals about PSA test among other issues".

The Task Force is an independent, government-supported volunteer group of experts from the nation in the field of prevention and evidence-based medicine.

"The most vulnerable men are getting less counseling", said study co-author Annie Gjelsvik, an assistant professor of epidemiology at Brown's School of Public Health.

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

The proposed guidelines do not specify how often men might want to screen their PSA levels, if they choose to do so. After the comment period ends, the task force will consider the input and come up with its final recommendation in the following months.

"The AUA commends the USPSTF for its decision to upgrade its recommendation for prostate cancer screening", AUA President Richard K. Babayan, MD, said in a statement. Well, now they say that wasn't quite right. The 2017 draft of the recommendations is based on new findings which tracked the effectiveness of PSA testing in clinical trials. Some cancers, ironically the ones easiest to diagnose and cure, are so slow-growing they are of no threat to the patient: They do not need to be cured, as they would never do harm if left alone.

More than 161,000 men in the United States will be diagnosed with prostate cancer in 2017, according to the American Cancer Society and almost 27,000 will die at an average age of 80. "These results give us confidence that we really have the full picture of the potential benefits of screening", says Bibbins-Domingo.

Darrell Sabbs, legislative affairs and community benefit manager for Phoebe Putney Health Systems suggested that, community outreach programs that serve high-risk groups should assist communication between members and clinicians, as in most cases these groups neither access the healthcare system nor have a talk with healthcare providers about PSA examination. If you treated everyone who was diagnosed with prostate cancer, which is what used to be done, most men would not benefit.

If you're a man between ages 55 to 69, one aspect of your medical care may have just gotten a little more confusing. For at-risk men, including men who are African-American, have a family history of prostate cancer, family history of breast cancer or the BRCA gene, and those who have been exposed to certain chemicals like fireman and veterans, as well as men over the age of 65 further assessment, is required.

WILLIAM BRANGHAM: So, forgive my sense of whiplash here, but help me understand, what is the task force recommending today?

Doctors' preferences appear to be winning out in the long-running debate about when screenings should begin for breast and prostate cancers.

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

So when the task force last issued guidelines in 2012, the panel decided the potential harms of screening outweighed the benefits.

And the urological association called the draft recommendation "thoughtful and reasonable", saying it was now in "direct alignment" with its own guidelines. The new statement also recognizes that the decision on whether or not to have a PSA test should be specific to each individual and an informed decision following a conversation between a man and his physician.

The absolute number or how quickly the number rises from one year to another helps doctors to determine if a prostate biopsy is indicated. "This is a "C" recommendation that says it should be considered, and the patient and his primary care physician should discuss the pros and cons of PSA based screening", Andriole says.