Prostate cancer tests are now OK with US panel, with caveats

7 2017 Dr. Kirsten Bibbins Domingo poses by a mural in the lobby of her office in San Francisco. Draft recommendations from the US Preventive Services Task Force ditch the old advice against

Recommendations Changing Slightly For Prostate Cancer Screening

The new guidelines considered research that found that "for every 1,000 men offered PSA screening, one to two will avoid death from prostate cancer and three will avoid prostate cancer spreading to other organs", CBS News reported. "The most important thing is for doctors and patients together to have a conversation", says Bibbins-Domingo, "so that men can make the best decision for themselves".

PSA-based screen and biopsies can not tell for sure which cancers are likely to be aggressive and spread or to grow so slowly as to never cause symptoms.

Blumberg is cancer free and his PSA is undetectable. PSA levels become elevated in cases of cancer-but also benign prostate problems.

Instead of treatment, many men with low-risk prostate cancer can opt for active surveillance, which may reduce the chance of overtreatment.

The controversial PSA blood test can save some men's lives from prostate cancer, an influential government panel said in new screening guidelines.

Dr. Anne Wallace, director of the Comprehensive Breast Health Center at UC San Diego Health, said that it doesn't surprise her that most doctors are not asking their patients to delay mammograms until they turn 50. It recommends against testing men aged 70 and older. From 2010 to 2013, screening rates among men in their 50s dropped from 33.2 percent to 24.8 percent, and in those ages 60 to 74, from 51.2 percent to 43.6 percent.

Urologist Dr. Edward Schaeffer, an advocate for widespread prostate cancer screening, welcomed the new report.

The new recommendation from the USPSTF is the latest chapter of a long debate over PSA-based prostate cancer screening. Most importantly, African Americans and people with a genetic history of the disease should ask their doctor about getting screened.

Many men who have high PSA levels undergo a biopsy, which provides vital insight into whether a man has cancer but can't predict how aggressive it might be. For many men with prostate cancer, their disease will progress so slowly that they would not die from it if it were left untreated. And one or two would be kept from dying of prostate cancer over a 10- to 15-year period. But with no effective way to tell the unsafe prostate cancers from the harmless ones, most men undergo surgery or radiation after diagnosis. That less aggressive approach to treatment minimizes the harms of screening, the task force says. Having every man undergo a PSA test without shared decision-making can open the floodgates in terms of procedures, the diagnosis of nonlethal prostate cancer, treatments, and side effects. While cancer death rates have declined over time, prostate and breast cancers are still projected to kill a total of almost 68,000 Americans this year, according to the National Cancer Institute and the American Cancer Society. The task force said that about 1 in 5 men who have their prostates removed suffer long-term problems with urinary incontinence that require pads. While some men may have symptoms, such as trouble urinating or back pain, for most the disease is silent. But preventing a small number of premature deaths would come at the expense of putting many, many more men through an unnecessary medical ordeal. Men with a family history of prostate cancer would also fall into this category.

However, in that same group, 235 men will be recommended for a biopsy, which can cause infection, bleeding and pain.

Last year, actor Ben Stiller announced that he had his prostate surgically removed in 2014, after testing revealed he had prostate cancer. Previously, in the 2012 opinion, the task force had also recommended against the test for the 55-to-69 age group, saying the possibility it lowered deaths from prostate cancer was "very small".

A lot of times, these are the types of cancer that occur in men earlier in life.

The task force's draft recommendation comes six months after it issued its findings in preliminary form. PSA screening remains a hard decision for healthy men and their doctors.

Some of those critics asserted that screening should be credited for a decline in USA deaths because of prostate cancer mortality over the last two decades.

However, the task force recommendations typically carry the most weight with doctors. When the panel's final recommendation is issued, it will figure in insurers' decisions about whether to cover the cost of PSA testing.

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