For two decades, Danny Tomlinson had an annual PSA screening, which is a blood test that measures the amount of a specific protein created by the prostate gland. When he was 61 years-old, the results of that test suddenly changed.
"My PSA had about doubled, and then six months later it had quadrupled. So we did a second biopsy and that one came back positive for prostate cancer," Tomlinson said.
That same PSA screening is now under fire by the U.S. Preventive Services Task Force, which has issued a draft recommendation against PSA testing for all men who do not have symptoms that are highly suspicious for prostate cancer.
The task force cites a high false positive rate, of up to 80 percent, which can lead to unnecessary biopsies and therapies that can have adverse side effects like incontinence and sexual dysfunction.
"You have to screen somewhere around 1,400 men in order to save one life. But everybody's definition of whether that's beneficial or not is different," said Dr. Mark Jones of The Urology Center of Colorado.
Jones admits the PSA test is imperfect, but according to guidelines established by the American Urological Association, he believes men should still get a baseline PSA screening at 40 years old, and follow-up screenings based upon risk.
"It is my belief that men under the age of 75 still will benefit from PSA-based screening with the caveat that they need to have at least a 10-year life expectancy," Jones said. "A man's risk of having prostate cancer in the U.S. is about one in six, yet a man's risk of dying from prostate cancer is about one in 30. So, out of 100 patients diagnosed with prostate cancer, only three of them are going to die of their disease.
The American Cancer Society has published the following guidelines regarding PSA screening:
"ACS recommends that men with no symptoms of prostate cancer who are in relatively good health and can expect to live at least 10 more years have the opportunity to make an informed decision with their doctor about screening after learning about the uncertainties, risks, and potential benefits associated with prostate cancer screening.
These talks should start at age 50. Men with no symptoms who are not expected to live more than 10 years (because of age or poor health) should not be offered prostate cancer screening. For them, the risks likely outweigh the benefits, researchers have concluded.
As in earlier guidelines, ACS recommends men at high risk -- African-American men and men who have a father, brother, or son diagnosed with prostate cancer before age 65 -- begin those conversations earlier, at age 45. Men at higher risk -- those with multiple family members affected by the disease before age 65 -- should start even earlier, at age 40. For men who are unable to make a decision about screening after these conversations, ACS recommends the doctor make the call based on his or her knowledge of the patient's health preferences and values."
The U.S. Preventive Task Force is seeking public input on its proposed recommendations regarding PSA testing until Nov. 8. To read the full report, or to share a comment, click here
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