Prostate cancer tests now OK with panel, with caveats

CHICAGO — An influential U.S. government health 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 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-fitsall” 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 U.S. Preventive Services Task Force says its latest recommendation 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 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.