Prostate cancer tests are now OK with panel, with caveats
In proposed guidelines released today, the U.S. Preventive Services Task Force advised men aged 55 to 69 to discuss the pros and cons of screening with their doctors rather than avoiding it altogether.
Brantley Thrasher, a urologist with the University of Kansas Health System and the president-elect of the American Urological Association, said patients have been getting diagnosed later, with their cancers more advanced, since 2012 because they're skipping the PSA screenings. The harms associated with treatment commonly include sexual impotence and urinary incontinence.
While PSA tests can detect prostate tumors at their smallest, most treatable stage, the testing has some risks, (Dr. Kristen Bibbins-Domingo, a professor of medicine at the University of California San Francisco) says.
Such an approach reduces the risk of aggressive treatments, which are reserved for cases where the cancer progresses. After following patients for a longer period of time, it was shown that for every 1,000 men screened, one to two lives were saved. These are complex decisions.
The prostate draft recommendation notes that the decision "to be screened for prostate cancer should be an individual one". That's updated from a blanket recommendation in 2012 for no routine screening at any age.
DR. KIRSTEN BIBBINS-DOMINGO: So, after the PSA test, you would have to have a prostate biopsy.
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.
Right now these guidelines are a draft and final recommendations could be decided in the coming months. Now a national task force that recommended against the PSA test is making a major shift. "That's an antidote to overdiagnosis and overtreatment", he said. Their recommendations influence US government policy, primary care physicians and private insurers' coverage decisions. He is now a medical student at the Johns Hopkins School of Medicine.
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"As a patient, you don't want to panic about a screening test", said Vapiwala. 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.
Nearly 3 million American men are now living with prostate cancer.
Critics of that recommendation anxious that as a result of any reduction in testing, prostate cancer might be diagnosed at a more advanced stage in some men. However, the task force still takes the position that screening often results in a false positive, which can lead to repeated blood tests and biopsies. They also saw that follow-up tests and treatments often caused serious problems.
Catching cancer early is essential to treating unsafe and aggressive forms of the disease, which can be a benefit from the test. Some physicians say such a trend has already begun, but others disagree. It can take several years for screening changes to affect cancer rates.
But as CBS2's Dr. Max Gomez reports, some experts say the new guidelines don't go far enough. Eventually, as the test continued to show an increase, his doctor ordered an MRI, discovered a mass and did surgery.
I'm joined now by the doctor who chairs that task force.
The task force's recommendations influence USA government policy and are widely followed by primary care physicians. This draft recommendation provides additional information to help support these men in making decisions about screening.
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". Those 70 and older shouldn't get screened. He called the new recommendations a step in the right direction. They just have a high PSA level. Patients with multiple medical problems who aren't expected to live much more than 10 years likely would get little benefit, Guzzo said. If the cancer grows and becomes a threat, then the patient can opt for surgery. That applies to men aged 55 to 69 of average risk for prostate cancer as well as those with higher odds, including blacks and men with a family history of the disease. It called for more research for this group.
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