U.S. Preventative Services Task Force Relaxes Opposition To PSA Testing For Prostate Cancer

Tuesday, May 2, 2017
Lee Jackson, M.D.
Lee Jackson, M.D.

U.S. Preventative Services Task Force has issued a draft recommendation statement on screening for prostate cancer, proposing a change to its previous recommendation for discontinuation of prostate-specific antigen testing. The task force’s revised guidelines do not completely reverse its 2012 recommendation against board-based prostate-specific antigen screening, but move from a “D” rating (discouraging testing because of relative certainty that it offers no net benefit or that benefits do not outweigh potential harm) to a “C” rating (recommending physicians should offer testing for specific patients depending on individual circumstances, noting a moderate certainty of a small net benefit). 
“I believe primary care physicians have struggled with the conflicting evidence that PSA is the only way to reliably detect prostate cancer and at the same time a government agency is recommending against screening,” says Jeffrey Mullins, M.D., robotic endourologist with CHI Memorial Chattanooga Urology Associates. “This change in prostate screening recommendations means the task force has recognized that PSA screening does have real benefits, it saves lives, and it now can be part of the discussion all men have with their doctors about their overall health.”

According to the American Cancer Society, an estimated 161,360 new cases of prostate cancer will be found this year, with 26,730 men dying from the disease. A man’s overall lifetime risk of developing prostate cancer is about 1 in 7. 
The updated recommendation, which is still under review, says men ages 55 to 69 should consult individually with their physicians about whether PSA testing is appropriate and what timetable they should follow. The task force maintains its recommendation against PSA testing for men age 70 or better, citing potential harm outweighs the benefits of testing for this age group. 

The recommendation against the routine use of this common blood test was a surprise to many men and their doctors. After the guidelines were released 2012, screening rates went down and so did diagnoses of prostate cancer, according to a report in JAMA. The European Randomized Study of Screening for Prostate Cancer also found PSA testing reduces the chances of developing advanced prostate cancer by about 30 percent and the risk of dying from the disease by about 20 percent. The task force decided to adjust its screening recommendations in part based on these new findings, but stopped short of recommending the test for everyone citing caution about over diagnosis and over-treatment that can lead to impotence or incontinence. 

The initial de-recommendation came from the task force’s view that over-treatment of men with low grade, non-lethal cancer, including having their prostate removed and undergoing radiation, was leading to side unnecessary side effects. Now with “active surveillance,” urologists are treating far fewer men with cancer and the harms of detecting prostate cancer are also decreasing. MRI is now predominantly used for detection and fewer biopsies are conducted, further decreasing the harms and costs associated with screening.  

“Prostate cancer is a highly variable cancer, and not all prostate cancers are associated with the same level of risk of progression. By estimating the risk of progression in the context of a man’s current health status and life expectancy, we can then make recommendations for managing that risk with one goal in mind: that no man dies from prostate cancer,” says Lee Jackson, M.D., robotic prostate cancer surgeon with CHI Memorial Robotics for Prostate Cancer. “Men are assigned to a category of risk based on their Gleason score and PSA, and each category is managed differently. If there’s a low risk, treatment isn’t necessary. If there’s an intermediate risk, recommended treatment is surgery or some form of radiation. Men with highest risk likely require a combination of surgery, radiation and hormone therapy. PSA screening helps give men the information they need to make the most informed decisions about their health.”  
This is a draft recommendation statement, with opportunity for public comment until May 8 at 8 p.m. The USPSTF reviews all comments and incorporates relevant information into the final recommendation statement. Comments may be submitted through this link: https://screeningforprostatecancer.org/.

For more information or to discuss these recommendations, call CHI Memorial Chattanooga Urology Associates at 423-697-0072 or CHI Memorial Robotics for Prostate Cancer at 423-495-3068.

Jeffrey Mullins, M.D.
Jeffrey Mullins, M.D.

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