Experts OK with prostate cancer testing


That's what would be important for us to really determine whether you have cancer. New evidence "increases confidence" that the PSA test reduces the risk of dying of prostate cancer or developing advanced cancer that spreads beyond the prostate. An elevated PSA may be caused by prostate cancer, but it may also be caused by an enlarged prostate or an inflammation of the prostate.

New guidelines released Tuesday morning provide refreshed guidance for prostate screenings. Ultimately the health panel claims that men between the ages of 55 to 69 should talk to their physician about the advantages and disadvantages of the PSA test. The PSA test became available in the mid-1980s.

The blood test isn't a diagnosis of cancer and it isn't good at detecting whether high levels of protein-specific antigens - a substance made by both good cells and cancer cells in the prostate - indicate cancer or are harmless.

The prostate cancer recommendations, announced online in the Journal of the American Medical Association, are open for public comment on the task force website until May 8.

Dr. Bibbins-Domingo is the Lee Goldman, MD endowed chair in medicine and professor of medicine and of epidemiology and biostatistics at the University of California, San Francisco (UCSF).

"It's the only time I've ever been happy the Army was kind of behind the times", Taylor said. Doctors should discuss the issues with male patients and help them decide whether to be screened. In this approach, doctors keep a close eye on men with a high risk of prostate cancer, rather than treating outright. Positive tests may lead to treatment for something that isn't risky. The task force said research on prostate cancer in African-American men "should be a national priority". And aggressive treatment, which includes removal of the prostate gland or radiation treatment, impairs sexual functioning in more than half of men and frequently results in incontinence.

"The PSA test is not a great test", Bibbins-Domingo says.

Men's Health Network (MHN) is an global non-profit organization whose mission is to reach men, boys, and their families where they live, work, play, and pray with health awareness messages and tools, screening programs, educational materials, advocacy opportunities, and patient navigation. In men age 70 years and older, the potential benefits of PSA-based screening do not necessarily outweigh the harms.

He said the agency's decision to propose a change in its rating for PSA tests, after advocating against them in 2012, reflects additional medical evidence that has appeared.

Prostate cancer cases are known for raising the levels of PSA found in blood through screenings. "The rates from the trials of prostate cancer screening suggest that about 20 to 50 per cent of these are overdiagnosed - that is, that they are prostate cancer, but of the type that are slow-growing, and not likely to cause a problem", Bibbins-Domingo told Action News. Instead, they and their doctors are opting for "watchful waiting" or active surveillance of the malignancy. The task force says the increasing use of watchful waiting is helping to spare more men the side effects of over-aggressive treatment.

Now, after reviewing follow-up evidence, the task force is recommending that men aged 55 to 69 have a discussion with their doctor about the pros and cons of PSA screening. Some men who are concerned about prostate cancer will elect to be screened, and others who are less concerned will not; doctors should support either decision.

And so that was what allowed us to say that, for some men, the harms might be reduced. The recommendations say nothing about men under 55, for whom some groups do recommend screening in some circumstances.

Taylor said the new recommendations will make it easier to get the PSA test covered by insurance.

So how useful is PSA screening?

The new recommendations come from the U.S. Preventive Services Task Force, a government-appointed volunteer panel of experts.

How does the prostate cancer test work?

At the same time, the specialty group took issue with the panel's decision to maintain its recommendation against screening for men 70 and older, saying that healthier older men might benefit from the test.

Dr. Gerald Andriole, Washington University urologist at Siteman Cancer Center, joins us to explain. We have new evidence that led to the change in our grade. And he worries the new guidelines are confusing.

Turini's team believes that doctors need to have a comprehensive discussion with their patients about the risks and benefits of PSA testing.