Should You Have a PSA Test? A New Viewpoint.

Men ages 55-69 who don’t get PSA (prostate-specific antigen) screening tests for prostate cancer may want to reconsider that choice based on an April 2017 recommendation from the United States Preventive Services Task Force (USPSTF), a government advisory medical panel who evaluate the benefits and harms of health services. A few years ago, this same panel discouraged many men from having the PSA test.

As  most of you know, the PSA test measures a protein level that rises both in men with prostate cancer and other prostate disorders. The test has several shortcomings including the risk of a  false-positive result.  Only about one in four men with an elevated PSA level who undergoes a prostate biopsy actually has prostate cancer according to the National Cancer Institute. However, a biopsy can have serious side effects such as bleeding, infection and pain. Up to half of prostate tumors identified by the PSA test and confirmed by a subsequent biopsy are harmless and will never cause symptoms or death. Yet many men proceed to treatment with surgery or radiation for low-risk cancers even though treatments can cause long-term side effects such as incontinence and erectile dysfunction.

In 2008, the USPSTF advised men 75 and older to pass on PSA screenings concluding that the potential harms outweighed the benefits of cancer detetction. In 2012, the panel extended the recommendation to include all men saying in essence “do not screen” resulting in a serious decline in PSA screening. Meanwhile the number of men over 75 diagnosed with prostate cancer that has metastasized rose from 7.8% to 12% according to the Journal of the American Medical Association Oncology. Authors of the study suggested that the decline in PSA screening led to the rising number of men being diagnosed with advanced prostate cancer.

The USPSTF has now reversed its course to some extent encouraging men ages 55 to 69 with average risk to discuss PSA testing with their doctors and share the responsibility for deciding whether or not to be screened for prostate cancer. The group still discourages testing for men younger than 55 or older than 69. Other groups such as the American Urological Association advise men with a family history of prostate cancer or African-American ancestry to begin screening  (including a digital rectal exam) before age 55. It is also reasonable for select healthy men in their early 70’s to request screening too since they may live an additional 15-plus years.

It is suggested you ask your doctor if you should be screened and why. For more information on prostate symptoms, see the Sept. 25th post. If you decide to be screened, discuss how often you should be tested; every other year makes sense for many men while annual testing may be preferable for those with risk factors.

Risk factors include age, race and family history. As you get older, the risk of developing prostate cancer increases dramatically. The average age at diagnosis is between 65 and 70 years. Black men are at highest risk whereas rates for white men and hispanics are 40-50% lower. Asian, Pacific Islander and American Indian men have the lowest rates. You have double the risk if you have a first-degree relative (father or brother) with prostate cancer. Second-degree relatives (uncle or grandfather) with prostate cancer confer only a small risk increase.

(Much of this material was taken from the Sept. 2017 issue of the University of California Berkeley School of Public Health Newsletter.)


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