Prostate exam up­date

Of­fi­cials drop manda­tory can­cer screen­ings for men

The Washington Times Daily - - NATION - BY LINDSEY TAN­NER

CHICAGO | An in­flu­en­tial U.S. gov­ern­ment ad­vi­sory panel is drop­ping its op­po­si­tion to rou­tine prostate can­cer screen­ing in fa­vor of let­ting men de­cide for them­selves after talk­ing with their doc­tor.

The new draft guide­lines re­leased Tues­day echo those of sev­eral lead­ing med­i­cal groups, but they don’t make the de­ci­sion any eas­ier for men: With their doc­tor’s help, they have to de­cide whether to take an im­per­fect PSA test that has a small chance of de­tect­ing a deadly can­cer and a larger chance of trig­ger­ing un­needed worry and treat­ment with se­ri­ous side ef­fects.

“This isn’t a one-size-fits-all” rec­om­men­da­tion, said the panel’s chair Dr. Kirsten Bib­bins-Domingo, a San Fran­cisco in­ternist who al­ready fol­lows the ad­vice and dis­cusses the po­ten­tial pros and cons with her pa­tients.

Men whose great­est con­cern is re­duc­ing their chances of dy­ing from can­cer are some­times will­ing to face the con­se­quences and choose test­ing. “Other men will re­al­ize the likely benefit is small and aren’t will­ing to risk the harms,” she said.

PSA screen­ing to de­tect the most com­mon male can­cer is among the most heated top­ics in men’s health. It in­volves a sim­ple blood test for el­e­vated lev­els of a pro­tein that may sig­nal can­cer but also can be caused by less se­ri­ous prostate prob­lems. It can find can­cer that fre­quently doesn’t need treat­ment be­cause it’s too small and slow grow­ing to be­come deadly. Doc­tors say there’s no good way to tell which early can­cers might be­come lethal. The next step is of­ten ra­di­a­tion or surgery to re­move the prostate, which may re­sult in im­po­tence and in­con­ti­nence.

The new rec­om­men­da­tions come from the U.S. Preven­tive Ser­vices Task Force, a gov­ern­ment-ap­pointed vol­un­teer panel of experts. The group says the change is based on new ev­i­dence in­di­cat­ing that rou­tine PSA blood tests can slightly re­duce some men’s chances of dy­ing from prostate can­cer and that dras­tic treat­ment can some­times be avoided with close mon­i­tor­ing when can­cer is de­tected.

The shift shelves the panel’s 2012 guid­ance, which prompted crit­i­cism from some urol­o­gists — spe­cial­ists who treat the dis­ease — and an­gered some prostate can­cer pa­tients cer­tain that PSA screen­ing had saved their lives.

The new ad­vice pub­lished Tues­day closely aligns the panel with med­i­cal groups that also sup­port shared de­ci­sion-mak­ing. The big­gest re­main­ing dif­fer­ence is tim­ing. The task force draft says screen­ing con­ver­sa­tions should be­gin at age 55. Other groups say start ear­lier, de­pend­ing on fam­ily his­tory of prostate can­cer and other fac­tors. It rec­om­mends against test­ing men aged 70 and older.

The panel leaves open how of­ten men should be screened. It does not rec­om­mend ear­lier test­ing for blacks and those with a fam­ily his­tory, but says they should know their risks are higher.

Dr. Meir Stampfer, a Har­vard Univer­sity can­cer ex­pert, called the new ad­vice “a more rea­soned ap­proach.” He said PSA tests make sense if they do not lead to overly ag­gres­sive treat­ment.

His re­search sug­gests that more than 1 in 5 men world­wide have un­de­tected prostate can­cer, in­clud­ing more than 40 mil­lion Amer­i­cans, but that most will die of other causes.

The task force’s 2012 ad­vice against screen­ing said there was lit­tle ev­i­dence that PSA screen­ing was re­duc­ing deaths. Since then, PSA screen­ing rates have de­clined by as much as 10 per­cent, and now fewer than one-third of U.S. men get the tests. Fewer men are be­ing di­ag­nosed with early-stage dis­ease, when it is more treat­able, while more are be­ing di­ag­nosed with more ag­gres­sive hard­erto-treat can­cer.

The panel says its new ad­vice stems from long-term re­search in­di­cat­ing 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.


Draft rec­om­men­da­tions from the U.S. Preven­tive Ser­vices Task Force ditch the old ad­vice against screen­ing for prostate can­cer and say whether to get tested should be left up to men aged 55 to 69 after be­ing in­formed of the pros and cons. Dr. Kristen Bib­bins-Domingo, the panel’s chair, said “this isn’t a one-size-fits-all” rec­om­men­da­tion.

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