An independent U.S. panel of experts has changed course on its recommendation against routine PSA screening of men for prostate cancer.

In a draft recommendation, the U.S. Preventive Services Task Force said men between the ages of 55 and 69 should be screened using the prostate-specific antigen test on an “individualized” basis. The panel concluded, in its new guidance, that the potential benefits of screening slightly outweighed the harm.

The new draft guidelines echo those of several leading medical groups, but they don’t make the decision any easier for men: With their doctor’s help, they have to decide whether to take an imperfect PSA test that carries a small chance of detecting a deadly cancer and a larger chance of triggering unneeded worry and treatment with serious side effects.

 

“This isn’t a one-size-fits-all” recommendation, said the panel’s chair, Dr. Kirsten Bibbins-Domingo, a San Francisco internist who already follows the advice and discusses the potential pros and cons with her patients.

Men whose greatest concern is reducing their chances of dying from cancer are sometimes willing to face the consequences and choose testing. “Other men will realize the likely benefit is small and aren’t willing to risk the harms,” she said.

Controversial call

In a 2012 recommendation that caused controversy within the medical community, the task force expressed concern that routine use of the PSA test was leading to unnecessary biopsies and other tests in men suspected of having prostate cancer.

Critics of that recommendation worried that as a result of any reduction in testing, prostate cancer might be diagnosed at a more advanced stage in some men.

According to new data released by the task force, the test would let three men out of 1,000 avoid metastatic cancer and would prevent one to two prostate cancer deaths in 1,000.

The revised guidance is based on the findings of the European Randomized Study of Screening for Prostate Cancer.  

A longer follow-up period revealed that slightly more men in the 55-69 age group benefited from screening when the disease was suspected.

‘Thoughtful’ policy

The American Urological Association is hailing the proposed new recommendation as “thoughtful and reasonable.”  But the association expressed concern that, under the guidelines, men 70 and older would not be screened for prostate cancer.

A statement issued by the association said, “We believe that selected older healthier men may garner a benefit from prostate cancer screening,” even though the group acknowledged there is limited evidence that men in this age group benefit from the PSA test.

The revised draft recommendation is open to public comment before a final recommendation is issued.

The U.S. Preventive Services Task Force is a national independent volunteer panel of medical experts created in 1984. It is funded, staffed and appointed by an agency of the U.S. Department of Health and Human Services. The task force is charged with making “evidence-based” recommendations about clinical preventive services, including health screenings, counseling services and preventive medications.

Some information for this report came from AP.
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