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

October 11, 2011 by  
Filed under Prostate Cancer News

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

In what promises to be a fierce debate, more people, survivors of prostate cancer and specialists/experts alike, are continuing to oppose the proposed “no PSA test” for people who don’t have any symptoms of prostate cancer.

As we reported in the other news stories on this subject, survivors of the condition insist that they were able to survive because of early detection of the cancer in their prostate.

The below news article is a follow up and shows some survivors who say this new recommendation should be thrown out because they wouldn’t have survived prostate cancer if it was in existence when they went for their PSA tests that discovered the cancer.

Don’t tell Gilles Vanasse that prostate cancer screenings are unnecessary. One saved his bladder.

Vanasse, 70, has no family history of prostate cancer, but two years ago his prostate specific antigen score jumped from two to four. While still considered in the normal range, his doctor suggested a biopsy.

The biopsy found cancer near Vanasse’s bladder. Doctors removed his prostate and today he is cancer-free.

“If I had not had a PSA test and saw it jumped a full two points, it could have spread to my bladder,” the Middletown resident said. “I was very fortunate.”

But a government panel believes too many U.S. men are unnecessarily screening for prostate cancer, the second leading cause of cancer death in U.S. men, behind lung cancer. Almost 241,000 cases of prostate cancer and nearly 34,000 deaths are expected this year, according to the American Cancer Society.

The U.S. Preventative Services Task Force on Friday released its new tentative recommendation that PSA blood test should no longer be part of routine cancer screening for healthy men regardless of their age, saying it does more harm than good.

In 2009, the same task force triggered a controversy after it recommended that women start regular breast cancer screening mammograms at age 50, not 40, saying the modest benefit of mammograms at the younger age must be weighed against the harms, such as unnecessary biopsies.

Currently, the medical community recommends annual prostate cancer screenings starting at age 50 for men, and at age 45 for black men or those with a history of the cancer. Screenings typically include a digital rectal exam and a PSA blood test.

The recommendation, if finalized this week, means that doctors shouldn’t bring up the option for healthy men. If a healthy man asks for a PSA test and wants it after being informed of the evidence, he should receive it. It also would remain appropriate to use the test as part of an exam for a man with prostate symptoms or a family history.

Most prostate cancer (66 percent) occurs in men over age 65. No major medical group recommends routine PSAs, and the same task force panel guidelines have long advised men over 75 to skip annual screenings, saying they are often unnecessary. The American Cancer Society recommended against routine screenings in March 2010.

The PSA blood test has become controversial in recent years because it has a high false-positive rate. Too much PSA in the blood can signal prostate cancer, but it can also signal a benign enlarged prostate or an infection.

Even if cancer is found, most prostate cancer takes 10 years or longer before it becomes life threatening.

One study estimated that two of every five men whose prostate cancer was caught through a PSA test had tumors too slow-growing to ever be a threat. The American Cancer Society says for every 100 men, 16 will develop prostate cancer in their lifetime but only three will die from it.

But biopsies and disease treatment can pose potential harmful side effects, including impotence, incontinence and infections. The task force pointed out that 30 percent of men treated for prostate cancer after a positive PSA test experience significant side effects from treatment.

Local urologists, though, pointed out that the task force, whose members are prevention and primary care experts, lack medical specialty expertise and often rely on large-scale statistical data for its recommendations.

Urologist Dr. Joseph Izes pointed out there is no “insignificant” prostate cancer diagnosis for men in their 50s and 60s, who have an expected life span of more than 10 years.

“Our concern is men at risk for prostate cancer aren’t going to be given the chance to be diagnosed at a curable stage,” said Izes, co-director of the Prostate Evaluation Program at Abington Memorial Hospital and on staff at Doylestown Hospital.

With the greater use of PSA testing, the death rate from prostate cancer dropped from 40 per 100,000 men in 1992 to fewer than 25 per 100,00 men in 2007, according to Large Urology Group Practice Association.

Izes added that to discourage the use of a life-saving technology, even if it is imperfect, is unreasonable when it’s the only one available.

“I’m concerned this sends a message that prostate cancer is not an important disease,” he added. “We’re talking about not screening for the second leading cause of cancer deaths in men. It’s kind of shocking actually.”

Urologist Dr. Robert Mino agreed that prostate cancer screenings are appropriate for younger men with a life expectancy of 10 to 20 years. The last thing he wants to see is a return to pre-PSA days of the 1980s when prostate cancer deaths were higher than today.

“To go back to where 50 percent of patients walking in the door already had bone metastasis, that is a step in the wrong direction,” he said.

Mino said he doesn’t think the task force recommendation will change screening protocols, at least not immediately. Now Medicare and most private insurance will pay for one PSA test a year for men of screening age, or two if the PSA score is elevated. The test generally costs about $50.

He added that urologists understand the PSA has a false-positive rate, and the potential side effects of diagnosis and treatment. Many factors go into whether doctors recommend screening, diagnosis and treatment including the patient’s age, overall health, life expectancy and family medical history. Read the full news article here.

As you can see, more people continue to insist there’s still a need for PSA tests for prostate cancer. The survivors are quick to explain how they owe their survival to the fact that the cancers were detected in good time, thanks to the PSA tests that discovered the rise in their PSA.

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

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