Prostate cancer tests are now OK with panel, with caveats

This is a different take than what they previously recommended years ago, when the task force suggested against prostate-specific antigen, or PSA, blood tests to screen for prostate cancer. They also saw that follow-up tests and treatments often caused serious problems.

"Clinicians should speak with their African American patients about their increased risk of developing and dying from prostate cancer, as well as the potential benefits and harms of screening", says Task Force chair Kirsten Bibbins-Domingo, Ph.D., M.D., M.A.S. Now, based on the latest research, the group says men 55 to 69-years-old should have a conversation with their doctor and make a personalized decision about PSA screening.

Although screening for cancers of the breast, cervix, lung, colon and rectum must be fully covered by health plans, the panel's recommendations against routine PSA testing means that insurers may require co-payments to cover some of the cost. Medicaid and many insurers cover PSA screening. The draft 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. Alexander Kutikov, a urological oncologist at Fox Chase Cancer Center, said the new approach is a "very welcome reversal" of the older, "quite radical" guidelines.

The more you follow the studies that look at the benefits of PSA screening, the more positive they are becoming, he said.

The group also notes that drastic treatment can be avoided with close monitoring when cancer is detected. Positive tests may lead to treatment for something that isn't unsafe. For many men with prostate cancer, their disease will progress so slowly that they would not die from it if it were left untreated.

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.

In 2012, 63 percent of men underwent PSA tests.

About 70 percent of men with elevated PSA do not have prostate cancer when they are biopsied, according to research.

In men age 70 and older, the group continues to conclude that any benefits of screening "do not outweigh the harms, and these men should not be screened". The task force says the median age of death is 80. PSA-based screening and prostate biopsies do not identify whether a cancer is aggressive or likely to spread. For many men, however, prostate cancer is slow-growing and takes many years to become life-threatening. Instead, they and their doctors are opting for "watchful waiting" or active surveillance of the malignancy.

As with mammograms, the task force saw that many doctors had continued to buck its standards, which are based on evidence gained from years of research and treatment for the overall USA population.

Newly released survey results show that most physicians aren't following recommendations from the powerful U.S. Preventive Services Task Force for women to generally start getting mammograms at age 50. There is new guidance out today from an influential task force. That's the most important thing to me. "That allows us to say that there is likely overall a small net benefit to screening". "Every man should be given the opportunity to consider screening, especially those at higher than average risk owing to race, family history, or other factors". That initial report drew some controversy, including from screening advocates who urged that the panel's report reflect stronger confidence in the lifesaving benefits of the PSA test.

The draft of the guidelines signals a major shift in prostate screening advice for men, which in 2012 discouraged testing for healthy men of any age. We have new evidence that led to the change in our grade. He said he also doubts harried primary-care doctors will have time to guide patients through complicated discussions on PSA testing, given the importance of talking about other issues like diet, exercise and colonoscopies. "And that will cause many more harms than good".

WILLIAM BRANGHAM: And there's a lot of urologists - and I know the American cancer society has come out. Bibbins-Domingo said the largest European studies have generally screened every two to four years.

  • Santos West