February 21, 2019 by John Fernandez
U.S. Panel Now Says ‘PSA’ Prostate Cancer Screenings May Be Beneficial
A prominent panel of U.S. healthcare experts now says a much-debated blood test for prostate-specific antigen, or PSA, could be beneficial for preventing prostate cancer in men ages 55 to 69.
The new draft recommendation released today by the U.S. Preventive Services Task Force (USPSTF) reverses its previously stated opposition to the PSA, citing its tendency for inaccurate readings that can result in over-diagnoses and unnecessary biopsies with potential side effects.
The newly proposed guidelines reflect those of several leading medical groups, but don’t offer any more clarity about the effectiveness of PSAs. The panel of experts now say that men ages 55 to 69 should seek their doctor’s advice on the likelihood that the PSA test can detect prostate cancer.
Talk With Their Doctor, Experts Urge
The panel stated that it “recommends individualized decision-making about screening for prostate cancer after discussion with a clinician, so that each man has an opportunity to understand the potential benefits and harms of screening and to incorporate his values and preferences into his decision.”
The USPSTF continues to recommend against PSA-based screening for prostate cancer in men age 70 years and older.
Many men with prostate cancer never experience symptoms, and without screening, would never know that they have it. Men over the age of 50 who are not in a high-risk category should still undergo a digital-rectal prostate examination as part of a general annual screening. It is still considered the most reliable initial test. The physician will feel the prostate for hard, lumpy or abnormal areas.
Men at Higher Risk for Prostate Cancer
The new recommendation applies to adult men, 55-69, without symptoms or a previous diagnosis of prostate cancer. The American Cancer Society recommends men at high risk — African-American men and men who have a father, brother or son diagnosed with prostate cancer before age 65 — consult with their doctors about screenings at about age 45 or earlier. Men facing an even higher risk — those with multiple family members affected by the disease before age 65 — should start even earlier, at age 40.
“If you fall into a higher-risk group, you certainly should tell your doctor about your family history to start screenings earlier than men who are not at risk,” said Rosendo Collazo, D.O., an internal medicine physician with Baptist Health Primary Care.
An elevated PSA level may be caused by prostate cancer but can also be caused by other conditions, including an enlarged prostate (benign prostatic hyperplasia) and inflammation of the prostate (prostatitis). This means that some men without prostate cancer may have positive screening results (or “false-positive” results). In some cases, a positive PSA test may result in an unnecessary “transrectal ultrasound-guided core-needle biopsy” of the prostate to diagnose prostate cancer.
The USPSTF says in its new recommendation that “adequate evidence from randomized clinical trials shows that PSA-based screening programs in men ages 55 to 69 years may prevent up to 1 to 2 deaths per 1,000 men screened from prostate cancer over approximately 13 years.”
The USPSTF is distributing a draft of its new recommendations until May 8 to receive feedback from the public. “The final recommendation statement will be developed after careful consideration of the feedback received,” the panel said.
“As with everything else, men should be informed about the effectiveness of the physical exam and the questions about the PSA,” said Dr. Collazo. “Be informed as opposed to just saying ‘OK’.”