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losangelesnewstoday.com June 28, 2017


Prostate cancer tests are now OK with USA panel, with caveats

12 April 2017, 03:21 | Violet Powell

Men Should Ask About Prostate Cancer Test, Panel Advises

Federal panel that opposed prostate cancer screening just changed its mind

Those conversations should start at 55. The PSA test isn't ideal.

PCEC's council of experts believes that men should receive a baseline PSA blood test at age 40 to determine risk stratification, based on this assessment, PCEC recommends that men establish a testing follow up schedule with their doctor.

A common blood test checks for elevated levels of prostate-specific antigens (PSA) in a man's blood, as an indicator that he may have prostate cancer.

In this photo taken Friday, April 7, 2017, Dr. Kirsten Bibbins-Domingo poses in her office in San Francisco.

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. It proposes shifting from the task force's recommendation against routine prostate cancer screening to a recommendation for informed and shared decision-making in which the physician and patient discuss the real risks of harm and the potential for lifesaving benefit before deciding on screening.

The draft recommendation and evidence reviews are posted for public comment for consideration in the final recommendation and evidence review.

Nearly 240,000 new cases of prostate cancer are diagnosed each year. The task force is charged with making "evidence-based" recommendations about clinical preventive services, including health screenings, counseling services and preventive medications.

The draft of the guidelines signals a major shift in prostate screening advice for men, which in 2012 discouraged testing for healthy men of any age. An influential health panel that once said no now says certain men may benefit as long as they understand the potential harms. One epidemiologic study suggests that more than 1 million American men received unnecessary treatment over the past 25 years. But first, they should have a talk with their doctor about the pros and the cons of the PSA test.

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"PSA screening saves lives", he says.

Indeed, it is fair to say the harms of prostate screening are better proven than the benefits, although benefits likely do exist.

"It literally misses as many prostate cancers as it finds", Brawley said. The task force said new data show that PSA screening in the younger group prevents 1 to 2 deaths from prostate cancer over 13 years per 1,000 men screened. Treatment often involves radiation or surgery, which can cause incontinence and impotence. We encourage those affected by prostate cancer to provide input on this important matter. "And having the U.S. Preventive Services Task Force discourage PSA screening has sort of created a whole generation of family practitioners and internists who feel that PSA screening is a bad thing to do for patients".

Prostate cancer is one of the most common types among men in the U.S.; almost 13 percent will be diagnosed with it over the course of their lifetimes, according to the National Cancer Institute. If you treated everyone who was diagnosed with prostate cancer, which is what used to be done, most men would not benefit.

"Many men will have a high PSA at some point in their lives, and most of those will not be prostate cancer but that will be something that the patient and doctor will be anxious about" and will evaluate, Krist told ABC News. These recommendations apply to male adults who have not been previously diagnosed with prostate cancer and have no signs or symptoms of the disease, and to male adults with average or increased risk for prostate cancer (eg, African-American, family history of prostate cancer).

The task force updates their guidelines every five years.

The new guidance stems from recent evidence of the benefits of screening, and from a movement among prostate specialists toward active surveillance.



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