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Prostate Screening Guidelines Proposal Upgrades View of PSA Test

Prostate Screening Guidelines Proposal Upgrades View of PSA Test

He said there was definitely a time when too many men were undergoing surgeries that could leave them impotent or incontinent after receiving a PSA test with higher-than-normal values.

PSA-based screen and biopsies can not tell for sure which cancers are likely to be aggressive and spread or to grow so slowly as to never cause symptoms.

The draft recommendation applies to adult men in the general USA population without symptoms or a previous diagnosis of prostate cancer as well as to men at increased risk of death from prostate cancer due to race or family history of prostate cancer, but provides additional information for those at increased risk. A normal PSA level does not always rule out the presence of cancer.

The USPSTF bases its recommendations largely on prospective trials, which the scientific community doesn't have a lot of in the area of prostate cancer screening. The test comes with many potential problems but brings the benefit of ever so slightly reducing the chance of dying from the cancer.

For that reason, the U.S Preventive Services Task Force (USPSTF) is advising men to discuss with their doctors whether screening makes sense for them, rather than skipping the test as they'd previously recommended for most men. "As the second leading cancer killer of men, it occupies a niche among diseases that closely parallels breast cancer among women both in terms of incidence and death rates in their respective populations", said Dr. Jean Bonhomme, a physician, board member of MHN, and founder of the National Black Men's Health Network. Those older than 70 shouldn't undergo PSA screening, the task force said.

The D rating remains for men 70 and older.

A 2015 study concluded that avoiding treatment of low-grade prostate cancer in Americans who would never die from the disease would save $1.32 billion per year. We just don't have enough evidence about how we can screen those men effectively, what's the best age to start, how often to screen.

Prostate cancer affects 101.6 out of every 100,000 men in the United States, according to the Centers for Disease Control and Prevention. So I use the analogy reluctantly, hesitantly, and only because I think it helps us think more clearly about screening. Moreover, the statement recognizes that African American men and men with advanced prostate cancer in their families are at a higher risk for prostate cancer, but it does not provide any guidance or recommendation for testing these men at an earlier age. PSA testing reduces the risk of dying of prostate cancer, but there is no evidence it reduces the risk of dying.

Even upon diagnosis, the difference between an aggressive prostate cancer that could kill and one that might languish harmlessly for decades is often unclear to physicians.

For example, a radiation treatment could translate into a bowel injury, urination problems and even impotence, so many patients could be confused about what they can do with a positive test.

For these men, the task force recommends withholding treatment and monitoring the cancer until it requires treatment. One epidemiologic study suggests that more than 1 million American men received unnecessary treatment over the past 25 years. Men with a family history of prostate cancer would also fall into this category. Because the test is imperfect, Brawley said, there are a number of missed cancers and false alarms.

Q: What do other groups recommend? Men who were diagnosed with prostate cancer were rushed to treatment with surgery, radiation or hormones. The task force continues to stress that the decision to screen or not is an individual one, and one that each man should discuss with his doctor. According to the American Cancer Society, 13 percent of men will be diagnosed with prostate cancer at any time in their lifetimes.

And the urological association called the draft recommendation "thoughtful and reasonable", saying it was now in "direct alignment" with its own guidelines.

"PSA screening saves lives", he says. The U.S. Food and Drug Administration approved the test for screening in 1994.

But the results of research from the last five years have changed that equation, the task force says. Many experts believe the sealant has no effect - not positive or negative - on the other teeth. The task force is taking public comments on it until May 8. Medicaid and many insurers cover PSA screening.

Dr. Todd Brandt with Allina Health's Metro Urology out of Woodbury says the proposed guidelines will be a good thing for those men who want to be tested.


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