Prostate cancer tests are now OK with U.S. panel, with caveats

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The new guidelines are relatively simple: Men between the ages of 55 to 69 should start a conversation with their doctors about whether to have a PSA test and focus on their own values and priorities.

An influential physician task force backed by the US government is softening its opposition to routine prostate cancer screening. 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.

Yet "the balance of benefits and harms is still close", said Kirsten Bibbins-Domingo, an internist at the University of California at San Francisco and task-force chair.

In 2012, the task force recommended against routinely checking the levels of prostate-specific antigen, or PSA, in the blood, saying that the risks outweighed the rewards.

The revised draft recommendation is open to public comment before a final recommendation is issued. The task force says the median age of death is 80.

One of the problems is that prostate cancer might take years to develop into a problem that must be dealt with medically, while the negative effects of overtesting are felt immediately, says task force member Alex H. Krist, MD.

"Given that most prostate cancers are slow growing, and given the risks of over-diagnosis and over-treatment, there is little evidence that men 70 and older benefit from PSA screening", said Dr. Quoc-Dien Trinh of the Brigham and Women's Hospital and Dana-Farber Cancer Institute Prostate Cancer Program in Boston. One epidemiologic study suggests that more than 1 million American men received unnecessary treatment over the past 25 years. But first, they should have a talk with their doctor about the pros and the cons o.

The USPSTF graded the draft recommendation "C", which means it considers the net benefit of PSA testing small. "Other men will realize the likely benefit is small and aren't willing to risk the harms", she said.

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"Some men who are very concerned about prostate cancer will elect to be screened, and others who are less concerned will elect not to be screened; either decision should be supported", he wrote. Nonetheless, many men undergo surgery and radiation, which can leave them incontinent or impotent. We encourage those affected by prostate cancer to provide input on this important matter. However, Meigs said that he and other family doctors have come to depend on the task force's recommendations, which are known for sticking closely to the available evidence.

Prostate cancer is the most common cancer in men with more than 161,000 new cases each year and over 26,000 deaths, according to the American Cancer Society.

The draft recommendation also applies to adult men who have not been previously diagnosed with prostate cancer and have no signs or symptoms of the disease, men at average risk, and men who are at increased risk for prostate cancer, including African-American men and men with a family history of prostate cancer.

One specialist views the new recommendation as a correction of an error the task force made in 2012. "In the end, men who are considering screening deserve to be aware of what the science says, so they can make the best choice for themselves, together with their doctor".

It's particularly challenging to know whether a man should be screened and even treated for prostate cancer.

"Men who have low-risk prostate cancer, they don't have to go right away to aggressive treatment", Bibbins-Domingo said.

"The importance of PSA testing is that it's bringing men into contact with the healthcare system", said Dr. Ramon Perez, an urologist and advisor to MHN.

AUA responds to USPSTF draft recommendations on screening for prostate cancer [news release].

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