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Task Force: Older men should discuss prostate cancer screening with physicians

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A panel of experts has released a draft recommendation that men aged 55 to 69 with no sign of prostate cancer should still talk to their physicians about whether they should be screened for the second leading cause of cancer deaths in American men.

The U.S. Preventive Services Task Force issued a contentious recommendation in 2012 leaning against screening among men of average risk because of the substantial potential harms associated with screening and treatment.

Prostate cancer screenings are done using a blood test that measures the amount of a prostate-specific antigen, a type of protein, in a man’s blood. When a man has elevated PSA, it may be caused by prostate cancer, but it could also be caused by other conditions such as inflammation of the prostate.

One of the challenges of prostate cancer is that a substantial proportion of prostate cancer grows so slowly that it would not harm the patient.  The task force found that detecting prostate cancer early might not reduce the chance of dying from the disease and that treatment often caused impotence and urinary incontinence.

But now the task force members, using new data from a European trial and evidence about current treatment practices, believe there is more evidence to suggest the benefits of the screening might outweigh the harms for certain men — and that the choice should be one made with their physicians.

“The benefits and harms of prostate cancer screening are closely balanced and our new draft guideline suggests that men discuss screening with their physicians,” said Stanford Health Policy’s Douglas K. Owens, who was a member of the task force during the development of the guideline.

“We now have a long-term follow-up from clinical trials that show modest benefits and more men are being treated with active surveillance which may mitigate some of the harms of overtreatment,” said Owens.

Some 181,000 men in the United States are diagnosed with prostate cancer each year. Of those, an estimated 26,000 men die from the disease.

The task force changed its draft recommendation for screening from a D to a C for men aged 55 to 69, but continues to recommend against men 70 and older being screened. The draft recommendation is open for public comment through May 8 on its new prostate cancer screening website.

“Prostate cancer is one of the most common cancers to affect men, and the decision about screening using PSA-based testing is complex,” said Task Force Member Alex H. Krist, MD, MPH. “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.”

The Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive serves such as screenings, counseling services, and preventive medications.

Task Force Chair Kirsten Bibbins-Domingo, PhD, MD, said members reviewed evidence on the benefits and harms of screening for men at higher risk for prostate cancer, such as African-American men and those with a family history.

“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,” said Bibbins-Domingo.

She noted that there remains a “striking absence” of evidence to guide high-risk men as they make their decisions about screening: “Additional research on prostate cancer in African-American men should be a national priority.”

Many national medical associations are aligned with the task force’s new recommendations, including the American Urological Association, the American Cancer Society and the American College of Physicians.

Some critics continue to have concerns about screening.

“In my mind, the greatest misconception about the test is that we say it ‘saves lives,’ when that is uncertain,” writes Vinay Prasad, an oncologist, in the popular medical blog, STAT News. “PSA testing reduces the risk of dying of prostate cancer, but there is no evidence it reduces the risk of dying,”