What to know about new advice on prostate cancer test

"I'm very pleased. I view this as a victory for PSA screening for prostate cancer", says Dr. William Catalona, a professor of urology at the Northwestern University Feinberg School of Medicine. "In many cases, these groups may not access the healthcare system and have dialogue with their medical professionals about PSA test among other issues". Some, such as the American Cancer Society, suggest the discussion should start at age 50; others, such as the task force, say it should start at 55. New evidence "increases confidence" that the PSA test reduces the risk of dying of prostate cancer or developing advanced cancer that spreads beyond the prostate. These are really important benefits but they occur in a small number of men,"said Dr. Kirsten Bibbins-Domingo, Chair, US Preventive Services Task Force". But doctors say advances in detection, and closely monitoring low risk cancers are helping men avoid drastic treatment.

The task force does not recommend PSA testing for men 70 and older, as the risks outweigh the benefits in this group. Bibbins-Domingo said that the final draft may come toward the end of the year, once the task force considers all the public comments it receives. But with more data on the subject, the task force now leans toward the benefits of screening.

"The balance has shifted", she added, "and now we can recommend that men have a conversation with their doctors about screening". An influential health panel that once said no now says certain men may benefit as long as they understand the potential harms. But many men can live with the disease for years without it causing serious illness. "They are opening it up to say, 'Have a talk with your doctor, and hey, this is an individual decision'".

The prostate draft recommendation notes that the decision "to be screened for prostate cancer should be an individual one".

"While we recognize the need for screening is greater in some men than others, we hope the latest recommendation will encourage all men to take a more active role in their health and wellness", said Ana Fadich, Vice President of MHN.

"It literally misses as many prostate cancers as it finds", Brawley said.

Prostate cancer screening is notoriously rife with uncertainty, and the previous 2012 guidelines advised against PSA testing. Treatment often involves radiation or surgery, which can cause incontinence and impotence.

The revised guidance is based on the findings of the European Randomized Study of Screening for Prostate Cancer.

The U.S. Preventive Services Task Force is a national independent volunteer panel of medical experts created in 1984.

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.

NY real estate executive Stephen Fredericks, 63, is a proponent of PSA testing.

According to the task force, many prostate cancers grow slowly or not at all, so some men will not experience any symptoms, nor will they die from the cancer.

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. There was promotion of screening, not just by doctors to their patients but by clinics, patient advocacy organizations and even an adult diaper manufacturer.

The task force updates their guidelines every five years.

The draft recommendation applies to adult men in the general US population without symptoms or a previous diagnosis of prostate cancer as well as to men at increased risk of death from prostate cancer due to race or family history of prostate cancer, but provides additional information for those at increased risk. Fewer men are being diagnosed with early-stage disease, when it is more treatable, while more are being diagnosed with more aggressive harder-to-treat cancer.

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