Prostate cancer tests are now OK with U.S. panel, with caveats

Fewer than one-third of men are getting screened for prostate cancer.

"Risk stratification and personalized medicine should be a key component of early detection", stated Wendy Poage, President of PCEC, "We have stressed the importance of prostate cancer markers in identifying men who should be biopsied and treated and developed an online tool to help patients understand these tests".

The U.S. National Cancer Institute provides more information on prostate cancer screening. Men with a family history of prostate cancer would also fall into this category. The test comes with many potential problems but brings the benefit of ever so slightly reducing the chance of dying from the cancer.

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

Good scientific research has bought about improved understanding of cancer and the limitations of screening tests, diagnostics and treatment. Screening saves an estimated one or two lives out of every 1,000 men who get screened.

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.

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. The task force is charged with making "evidence-based" recommendations about clinical preventive services, including health screenings, counseling services and preventive medications.

Two Philadelphia prostate cancer experts saw the new guidelines as a welcome change. Well, now they say that wasn't quite right. But none of that has to happen just because an initial PSA test turned up positive.

And if someone has a slow-growing prostate cancer that doesn't necessarily need treatment, the emotional distress of a cancer diagnosis shouldn't be underestimated, Turini said.

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Though the draft recommendation applies to African-American men, who are at increased risk for developing and dying from prostate cancer, task force chair Kirsten Bibbins-Domingo, MD, PhD, said this high-risk group has been woefully understudied.

"We have to work based on solid evidence that is in the medical literature and make a decision based on the balance of benefits and harms", Krist said. He says he wishes the group had gone further and recommended that doctors actively encourage PSA screening beginning at age 40 and continuing past age 70. As a result, Guzzo said, he has been seeing more patients whose cancer is at a higher grade or size when it is caught.

PSA tests measure the amount of a certain protein in the blood. One epidemiologic study suggests that more than 1 million American men received unnecessary treatment over the past 25 years. African-American men, men with a family history of the disease, and men exposed to Agent Orange and some other chemicals are at greater risk. "Men who are more interested in avoiding the potential harms may choose not to be screened".

Doctors' preferences appear to be winning out in the long-running debate about when screenings should begin for breast and prostate cancers.

Both physicians said the older rules had the effect of greatly reducing how many men discussed prostate cancer screening with primary care doctors. 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. Read the new advice here.

So when the task force last issued guidelines in 2012, the panel decided the potential harms of screening outweighed the benefits.

William Nelson, director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, said the guideline shift reflects the increased use of active surveillance for low-risk prostate cancer. Medicare and many private insurers have continued to pay for the screening.

And the urological association called the draft recommendation "thoughtful and reasonable", saying it was now in "direct alignment" with its own guidelines.