Experts shift gears on routine prostate cancer screenings

If you are a man age 55 to 69 with no signs of prostate cancer, you may still want to talk to your doctor about getting your PSA levels checked — but having that conversation with your physician is key.

That is the recommendation made Tuesday by a U.S. government advisory panel, five years after it issued guidance advising against routine screening of prostate-specific antigen levels, known as PSA, in the blood. At the time, the U.S. Preventive Services Task Force said the risks outweighed the benefits.

“We looked at evidence overall, and there could be a small benefit for some men to be screened for prostate cancer,” Dr. Alex Krist told USA TODAY, explaining why the group shifted on its guidance. “We aren’t recommending you routinely get screened. Patients should talk with their doctors about the pluses and minuses.”

The 2012 guidance against routine screenings for men under 70 led to criticism from some doctors who treat prostate cancer as well as patients, who said PSA screenings helped save their lives. Since then, the task force has studied new data, Krist said, which showed “slightly more men might not die” if they had screenings.

Other than skin cancer, prostate cancer is the most common cancer in U.S. men, according to the American Cancer Society. It estimates there will be 161,360 new cases of prostate cancer in 2017 — with about 26,730 deaths.

PSA screening involves a simple blood test for elevated levels of a protein that may signal cancer but also can be caused by less serious prostate problems. It can find cancer that frequently doesn’t need treatment because it’s too small and slow growing to become deadly. Doctors say there’s no good way to tell which early cancers might become lethal. The next step is often radiation or surgery to remove the prostate, which may result in impotence and incontinence.

The task force’s 2012 advice against screening said there was little evidence that PSA screening was reducing deaths. Since then, PSA screening rates have declined by as much as 10%, and now fewer than one-third of U.S. men get the tests. Fewer men are being diagnosed with early-stage disease, when it is more treatable, while more are being diagnosed with more aggressive harder-to-treat cancer.

Research since 2012 also has shown the benefits of “active surveillance” of men with low-grade prostate cancers, Krist said. That approach involves rechecking PSA levels and doing biopsies. “It might delay surgery” or other types of treatment, he said.

Most most men diagnosed with prostate cancer do not die from it, the American Cancer Society says: More than 2.9 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.

Krist says the No. 1 takeaway from Tuesday’s guidance is this: “Men should talk with their doctors about the pluses and minuses and only get checked after fully understanding them. Be informed: Think about what’s right for them.”

The draft prostate cancer recommendations, announced online in the Journal of the American Medical Association, are open for public comment on the task force website until May 8. Final guidance will come months later.

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Dan Mullin is an active writer and editor for the Pluto Daily who covered the 2014 Ebola Outbreak. Mullin attended the Wake Forest School of Medicine before leaving to pursue his lifelong science goal of allowing humans to live forever via a computer/brain transfer.