Updated PSA Screening Guidelines Now Stress Patient Choice
When three different prostate cancer websites post the same subject article, it is significant. According to the April 11th MedLinePlus from the U.S. National Library of Medicine, in a significant shift, a key health advisory panel plans to soften its recommendation against prostate-specific antigen (PSA) screening for detecting prostate cancer. In 2012, the U.S. Preventive Services Task Force recommended that men no longer get their PSA tested. That recommendation was based on evidence that PSA screening resulted in overdiagnosis and unnecessary treatment that could leave men impotent and incontinent. Now, after reviewing follow-up evidence, the task force is recommending that men aged 55 to 69 have a discussion with their doctor about the pros and cons of PSA screening. For men aged 70 and older, the recommendation for no PSA screening remains in place.
The recommendation states PSA-based screening provides a small benefit for men ages 55 to 69, and that physicians should inform this group about the potential benefits and harms of PSA-based screening for prostate cancer. In addition, the statement pointed out that the decision of whether to screen or not should lie with the individual man, after an informed discussion with his physician.
The task force is an independent, volunteer panel of experts in prevention and evidence-based medicine that makes recommendations about preventive medical services, such as screenings, counseling services, and preventive medications.
“There is probably a small benefit overall to screening,” said task force chair Dr. Kirsten Bibbins-Domingo. She is a chair in medicine and a professor of medicine, epidemiology and biostatistics at the University of California, San Francisco. “But the right decision is not a one-size-fits-all decision. The right decision isn’t screening all men, it’s making all men aware of the benefits and harms, and then allowing each man to make the best decision for himself,” Bibbins-Domingo explained. The recommendation applies to men who have not been diagnosed with prostate cancer and have no signs or symptoms of the disease, Bibbins-Domingo said. In addition, the recommendation is for men at average risk and those at increased risk for prostate cancer, such as black men and men with a family history of prostate cancer. Men at increased risk for prostate cancer should take that into consideration when making the decision to be screened for PSA levels, she said.
One specialist, Dr. Anthony D’Amico a professor of radiation oncology at Harvard Medical School. views the new recommendation as a correction of an error the task force made in 2012. The more you follow the studies that look at the benefits of PSA screening, the more positive they are becoming, he said. Because prostate cancer takes many years to develop, the benefit only becomes apparent 10 to 20 years after the start of a study, he explained. Based on longer follow-up of studies, “the task force is backing off from, ‘Do not screen,’ to ‘Let’s talk about it,’ and then, I would say, in time, it will probably come to, ‘We think you should do it,'” he said.