Disparities Growing in Prescreening Discussions About Prostate-Specific Antigen Testing

Posted April 18, 2017

David Mullen is a textbook case of a potentially life-saving medical test done badly. It holds that discussion should also emphasize the significant advancements in the detection and staging of prostate cancer and that PSA is just one of many tests available to help make an educated decision. His PSA had shot up to 14.7ng/mL. "Another important benefit from PSA screening is in helping the reduction of the risk of metastatic cancer in which the cancer has spread beyond the prostate to other areas of the body making it more hard to cure". It can find cancer that frequently doesn't need treatment because it's too small and slow growing to become deadly.

PSA screening still has all the harms we hear so much about: false positives, overdiagnosis - which means treating a cancer that would otherwise not cause harm - and the side effects of diagnosis and treatment, including incontinence, impotence, and even death.

"The decision to whether to begin PSA screening is not always easy for men".

"The decision about whether to be screened for prostate cancer should be an individual one", the U.S. Preventive Services Task Force said in a draft recommendation issued Tuesday.

"Although the overall mortality of prostate cancer really hasn't changed, the frequency of men who develop metastatic prostate cancer and subsequently require more expensive, more invasive, more challenging therapies has increased", Dr. Petruzzelli said.

"What we need to do is keep the screening but make better decisions about when to biopsy and when to treat prostate cancer", says Hamilton.

Chief medical officer, American Cancer Society, Inc. "When it's closed, it's closed for good", Professor Loeb said. They propose shifting from 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 life saving benefit before deciding on screening.

"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 from prostate cancer over approximately 13 years per 1,000 men screened".

"We believe our findings may be indicative of a shift in practice patterns away from detailed prescreening discussions among health care providers who have implemented the 2012 (USPSTF) recommendation into their caregiving", the study authors wrote.

The Urological Society of Australia and New Zealand welcomed the draft guidelines, having long argued the old recommendations were flawed and harmful. Other groups say start earlier, depending on family history of prostate cancer and other factors.

"It's not a flawless test".

In the days since that update was published, some media headlines have made it seem as if the USPSTF has "changed its mind" or is now "OK" with PSA-screening.

But testing for additional prostate cancer markers through blood, urine and tissue samples, and understanding patient risk profiles was helping doctors better identify which patients would likely benefit from treatment and who could forego it, she said.