U.S. guidelines relax opposition to prostate cancer screening

(Reuters Health) – An influential physician task force backed by the U.S. government is softening its opposition to routine prostate cancer screening.

In proposed guidelines released today, the U.S. Preventive Services Task Force advised men aged 55 to 69 to discuss the pros and cons of screening with their doctors rather than avoiding it altogether. The task force continued to recommend against a blood test for prostate specific antigen (PSA) in men 70 and older, concluding the potential harms of routine screening still outweigh the benefits for this age group.

Since the last guidelines came out in 2012, new evidence has emerged suggesting that PSA tests may help lower the odds that tumors spread to other parts of the body or prove fatal for men aged 55 to 69, said task force chair Dr. Kirsten Bibbins-Domingo, a researcher at the University of California, San Francisco.

New evidence also suggests it’s becoming more common for doctors to skip aggressive treatments like surgery or radiation for men with low-risk prostate tumors in favor of doing periodic tests to see if tumors grow, an approach known as active surveillance.

“This new evidence led the task force to conclude that there is now a small net benefit to screening, although we continue to note that the balance of benefits and harms are close,” Bibbins-Domingo said by email.

Most men with prostate cancer are diagnosed with low-risk tumors that haven’t spread to other parts of the body. Often, doctors and patients struggle to choose between active surveillance and treatments like surgery or radiation because it’s hard to tell which tumors will grow fast enough to be life-threatening and which ones might never get big enough to cause problems.

The task force draft recommendations apply to PSA tests for men without any symptoms that might point to prostate cancer. Symptoms vary, but can include urinary difficulties or loss of bladder control, swelling in the legs or pelvic area, blood in the semen, painful ejaculation or erectile dysfunction.

Because primary care physicians who do the majority of PSA testing cut back on the practice after the task force advised against it, the new guidelines may lead more men to get screened, said Dr. John Davis, a urology researcher at the University of Texas MD Anderson Cancer Center in Houston who wasn’t involved in the recommendations.

“It’s not like doing less screening only cut back on over-diagnosis and over-treatment of low risk cancer,” Davis told Reuters Health. “It also decreased diagnosis of intermediate and high risk potentially lethal disease.”

With the new guidelines, the task force joins the American Cancer Society and the American Urological Association in encouraging men to discuss the benefits and harms of screening with doctors to make a joint decision. Patients should keep in mind that black men and those with a family history of prostate cancer are at greater risk, while also considering that PSA tests may lead to unnecessary procedures that have side effects like impotence and incontinence.

“Given that most prostate cancers are slow growing, and given the risks of over-diagnosis and over-treatment, there is little evidence that men 70 and older benefit from PSA screening,” said Dr. Quoc-Dien Trinh of the Brigham and Women’s Hospital and Dana-Farber Cancer Institute Prostate Cancer Program in Boston.

“At risk patients (men with a family history and black men) are more likely to die from prostate cancer, therefore these individuals are conceptually more likely to gain from PSA screening,” Trinh, who wasn’t involved in the task force recommendations, said by email.

The trouble, as the task force notes in its new guidelines, is that even these patients with added risk don’t have solid proof that PSA tests will help them.

“While it makes theoretical sense that screening may be beneficial for them, there is not enough evidence to suggest that detecting their cancer early will, in the end, make a difference,” Trinh said. “Patients should have a discussion with their primary care physicians about the pros and cons of screening.”

The draft recommendation is available online for public input until May 8. The final recommendation statement from the task force will be developed after the comment period closes.

SOURCE: bit.ly/2o019rz U.S. Preventive Services Task Force Prostate Cancer Screening Draft Recommendations, online April 11, 2017.

 

LINK http://www.reuters.com/article/us-health-prostate-screening-usa-idUSKBN17D20C

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