Yesterday, the United States Preventive Services Task Force released a draft recommendation that states healthy men should no longer receive a P.S.A test for prostate cancer as it often leads to unnecessary testing and procedures and does not save lives.
Below is a response to the suggested new guidelines from Christopher Kane, MD, FACS, professor of surgery, chief of the Division of Surgery, and director of the Urology Residency Training Program with UC San Diego School of Medicine:
“I disagree with the conclusion of the U.S. Preventive Medicine Task Force concerning PSA screening. Other major health organizations, including the ACS and AUA also disagree with that conclusion. The largest and best designed of the screening studies quoted in the report did show that the screening appeared to save lives. Although it is true that many men with low risk prostate cancer do not benefit from treatment, I am in favor of screening and detection, however avoiding invasive treatment in men who are unlikely to benefit.
At UCSD, we offer many men with low risk prostate cancer active surveillance rather than aggressive treatment. However, that decision is based on careful individualized assessment of risks and benefits. Many men with prostate cancer who were destined to have adverse outcomes are cured with current treatments. Also, current treatments are more refined and have fewer side effects than in prior eras. Finally, new therapies, recently approved for patients with advanced prostate cancer, may be useful in combinations with current treatments for men with newly diagnosed prostate cancer.”
Prostate cancer
The American Cancer Society recommends that men make an informed decision with their doctor about whether to be tested for prostate cancer. Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment. The American Cancer Society believes that men should not be tested without learning about what we know and don’t know about the risks and possible benefits of testing and treatment.
Starting at age 50, talk to your doctor about the pros and cons of testing so you can decide if testing is the right choice for you. If you are African American or have a father or brother who had prostate cancer before age 65, you should have this talk with your doctor starting at age 45. If you decide to be tested, you should have the PSA blood test with or without a rectal exam. How often you are tested will depend on your PSA level.
A team of UC San Diego Moores Cancer Center experts is available to speak about the new suggested guidelines.
What the revised guidelines say
Because of these complex issues, the American Cancer Society recommends that doctors more heavily involve patients in the decision of whether to get screened for prostate cancer. To that end, ACS’s revised guidelines recommend that men use decision-making tools to help them make an informed choice about testing. The guidelines also identify the type of information that should be given to men to help them make this decision.
ACS recommends that men with no symptoms of prostate cancer who are in relatively good health and can expect to live at least 10 more years have the opportunity to make an informed decision with their doctor about screening after learning about the uncertainties, risks, and potential benefits associated with prostate cancer screening. These talks should start at age 50. Men with no symptoms who are not expected to live more than 10 years (because of age or poor health) should not be offered prostate cancer screening. For them, the risks likely outweigh the benefits, researchers have concluded.
As in earlier guidelines, ACS recommends men at high risk – African-American men and men who have a father, brother, or son diagnosed with prostate cancer before age 65 – begin those conversations earlier, at age 45. Men at higher risk – those with multiple family members affected by the disease before age 65 – should start even earlier, at age 40.
For men who are unable to make a decision about screening after these conversations, ACS recommends the doctor make the call based on his or her knowledge of the patient’s health preferences and values.
For men who choose to be screened after discussing the pros and cons with their doctor, the new guidelines make the digital rectal exam (DRE) optional and offer the option of extending the time between screening for men with low PSA levels.
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Source: University of California, San Diego Health Sciences
