In a reverse move certain to cause some confusion, the U.S. Preventive Services Task Force has released revised PSA guidelines.
The task force, which recommended against routine PSA screening in 2012, now says men ages 55 to 69 should decide individually with their doctors whether and when to undergo the testing. It continues to recommend against prostate-specific antigen, or PSA, testing for men age 70 and older, saying potential risks outweigh any rewards of routine screening for this age group.
The 2012 recommendation was based on evidence that PSA screening resulted in overdiagnosis and unnecessary treatment that could leave men with urinary incontinence and sexual impotence. (Note about 70 percent of men with elevated PSA do not have prostate cancer when they are biopsied.) In addition, many PSA-detected cancers grow so slowly that some men are likely to die from something else instead.
“We were very concerned in 2012 that many, many men were being treated for prostate cancer,” said Kirsten Bibbins-Domingo, M.D., a professor of medicine at the University of California, San Francisco, and chair of the task force.
But new research, some of which suggests a small net benefit from screening, led the USPSTF to adjust its recommendation. “The new evidence allowed us to say that we think now the benefits do outweigh the harms,” Dr. Bibbins-Domingo said. “There is probably a small benefit overall to screening. The right decision is not a one-size-fits-all decision. The right decision isn’t screening all men, it’s making all men aware of the benefits and harms, and then allowing each man to make the best decision for himself. Now we can recommend that men have a conversation with their doctors about whether screening is right for them.”
PSA tests can detect prostate tumors at their most treatable stage, and several studies have reinforced not only the benefits of the tests, but also ways to lessen screening harms, including unnecessary biopsies and treatments.
One study in particular, the European Randomized Study of Screening for Prostate Cancer, found PSA testing cuts the chances of developing advanced prostate cancer by about 30 percent and the risk of dying from the disease by about 20 percent.
Some doctors are praising the USPSTF’s change of heart. “I view this as a victory for PSA screening for prostate cancer,” William Catalona, M.D., a professor of urology at the Northwestern University Feinberg School of Medicine told NPR. “PSA screening saves lives. 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. If this were to continue, we would lose all these gains in reducing the prostate cancer death rate.”
Otis Brawley, M.D. the American Cancer Society’s chief medical officer, agrees with the USPSTF’s revised guidelines, though for different reasons than Dr. Catalona.
“Prostate screening has been a contentious issue ever since the prostate specific antigen test became available some 30 years ago,” Dr. Brawley wrote today in a CNN commentary. “PSA has been shown to have a high false-positive rate and a high false-negative rate—literally missing as many prostate cancers as it finds.”
But, he told NPR, “I really do think that there is a pendulum in a lot of things that we do in medicine. And the pendulum here may be getting to the right place where we realize there are harms and there are benefits, and individuals need to weigh these harms and benefits and tailor a decision that’s right for them.”
The recommendation does not specify how often men might want to have their PSA levels screened. It is directed at men with average risk and those at increased risk of prostate cancer, such as black men, who are about two times as likely to succumb to prostate cancer as the general population, or men with a strong family history of the disease. But Dr. Bibbins-Domingo said further study is needed to figure out whether to screen these high-risk men more aggressively than those in the general population.
Prostate cancer is one of the most common types among men in the U.S., with nearly 13 percent being diagnosed with it over the course of their lifetimes, according to the National Cancer Institute. Roughly 180,000 American men are diagnosed with prostate cancer each year; at least 26,000 die annually from the disease.