No Prostate Cancer PSA Screening Recommended By U.S. Health Panel – More Follow Up

October 21, 2011 by  
Filed under Prostate Cancer

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It’s important to hear the voices from many patients and survivors of the condition. They have been talking about how they were saved because of early detection.

Medical professionals however are quick to tell their patients not to listen to the proposed recommendation. Many of them have condemned it outrightly.

Just two years after the U.S. Preventative Services Task Force (USPSTF) released controversial recommendations for breast cancer screening, the USPSTF has now released its recommendations against using prostate-specific antigen (PSA) tests to screen for prostate cancer.

Similar to the USPSTF’s 2009 recommendation that women younger than 50 should not get a mammogram to screen for breast cancer, the prostate cancer screening recommendation has caused an uproar, especially from those who have fought passionately to increase prostate cancer awareness. Another similarity between these two issues is that for both breast cancer and prostate cancer, the death rates are higher among blacks.

Per the American Cancer Society, African American men have a 58 percent higher rate of prostate cancer and more than twice the prostate cancer deaths, compared to white men. So if the disease is more common among black men and more likely to result in death, why would the USPSTF recommend against using the PSA test for prostate cancer screening?

The USPSTF is an independent panel of non-Federal experts in prevention and evidence-based medicine. This panel consists of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists). The purpose of the USPSTF is to review the scientific evidence of a range of clinical preventive health care services (such as screening, counseling, and preventive medications) and develop recommendations for primary care clinicians and health systems.

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The recommendations from this group often affect clinical care and may also impact health insurance.

In reviewing the scientific evidence, the USPSTF found the following regarding the PSA:

In men aged 70 years and older, PSA screening did not reduce deaths.

In men aged 50 to 69 years, the death rates due to prostate cancer 10 years after PSA screening did not improve.

After following men with prostate cancer for 12 years, 95 percent of those whose prostate cancer was detected by PSA did not die from that cancer, even without cancer treatment.

Over the last decade, the PSA has been highly promoted for prostate cancer screening so this information and the USPSTF recommendation is very surprising to many health providers, patients, health advocates and the public in general.

One of the challenges is that prostate cancers detected by PSA screening are most often diagnosed in men with no symptoms. (That is the principle of screening. If a person has symptoms, it is not screening, it is diagnostic.) The PSA is nonspecific and an elevated PSA can indicate an enlarged prostate, a prostate infection, prostate injury or prostate cancer. Also a PSA cannot determine the type, grade, or stage of prostate cancer.

Many prostate cancers detected by PSA are slow-growing and may never cause health problems or affect the man’s life expectancy. Additionally, treatment for prostate cancer can result in side effects such as incontinence and erectile dysfunction.

So the USPSTF’s review found that using the PSA to screen for prostate cancer did not save lives and that the prostate cancer treatment that resulted from the PSA screening caused some undesirable side effects.

Here is the problem with the USPSTF’s review. The studies reviewed by the USPSTF did not include a substantial number of African American men. This wasn’t on purpose. Few black men were included because few black men participated in the studies. It is impossible to determine whether African American men who have the highest prostate cancer rates and prostate cancer deaths would benefit from PSA screening if they are not well-represented in the research studies.

Gerald Andriole, MD, chief of urology at Washington University School of Medicine recently recommended a compromise during an interview with the New York Times.

“Rather than throw PSA away, we should make a plausible adjustment that only certain men should be screened,” he said. Instead of screening all men, screening should be focused on those at high risk of the disease, including black men and those with a family history of prostate cancer, he explained.

If you are a man over the age of 40, talk to your health care provider about the risk and benefits of screening for prostate cancer. Given the complexities of prostate cancer screening, this discussion should be based on your individual health and family history. Source.

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