What’s new in prostate cancer screening guidelines

Prostate cancer screening tests have made the headlines again recently due to a change in recommendations about the prostate-specific antigen (PSA) test. The United States Preventive Services Task Force (USPSTF), an independent and influential panel of experts, updated its guidance beginning in 2012. The new guidance, which is still in draft form as the task force seeks public comment, marks an evolution in the committee’s thinking. . . Her recommendations: Men between the ages of 55 and 69 should make an individual decision about prostate cancer screening with their doctors.

“These new guidelines recognize that prostate cancer screening is a personal medical decision, not just a public health decision,” says Dr. Shaun Kavanaugh, a radiation oncologist, at our hospital near Atlanta. “The USPSTF wants men to know about prostate cancer screening options and talk to their doctors.”

Who gets prostate cancer?

About 161,000 men in the United States will be diagnosed with prostate cancer this year, according to the American Cancer Society. The median age at diagnosis is 66. The USPSTF advises against PSA-based screening for men over 70 years of age. The committee had no new recommendations for men at increased risk of prostate cancer, including African American men and men with a family history of the disease.

In 2012, the task force made a controversial recommendation: It advised most men not to be screened for prostate cancer with the PSA test. Recent studies show that PSA detection rates have decreased significantly in the United States since then. “The original problem wasn’t that the men found out they had cancer,” says Dr. Kavanaugh. The original problem was when they discovered that the medical community and patients were overreacting. This has cured many diseases that do not need treatment and caused a lot of damage.”

For years, experts differed about whether and when men should be screened for prostate cancer. The examination usually includes a PSA test. Results with a high PSA can be a sign of prostate cancer, but a high PSA can also be due to other conditions, such as prostatitis or an enlarged prostate. Historically, biopsies were taken for men with elevated PSA levels. A positive biopsy generally resulted in a cure. But prostate cancer treatment, including surgical removal of the prostate and radiation, is associated with urinary incontinence and erectile dysfunction.

New tools

“In treating the majority of men diagnosed, the medical community has been spending an enormous amount of money and it has been detrimental to the sexual and urinary health of many men,” says Dr. Kavanaugh. “Now, with our new tools and these new guidelines, clinicians can identify men who can really benefit from treatment, with a commitment not to treat men we don’t think would benefit.”

These new tools include genetic testing of tumors to see if cancer is aggressive, and 3-D imaging, known as multifactorial magnetic resonance imaging, which allows doctors to monitor the entire prostate and helps guide decisions about treatment options. Monitoring cancer with regular blood tests and digital rectal exams is known as active monitoring. Researchers have found that active prostate cancer surveillance is as effective as more aggressive treatments for low-risk men with early-stage disease.

Dr. Kavanaugh says the debate between men who have had positive prostate cancer biopsies and their doctors should change, too. “It has to start with whether the cancer needs treatment at this point,” he says. “For patients with very low risk and low risk of cancer spread, shouldn’t the conversation begin with how we treat it? It should include alternatives to definitive treatment, with the least potential to harm or compromise your quality of life. Then, for patients at higher risk, they can That the conversation moves directly to treatment options. But by starting the conversation by asking if it should be treated, confidence is gained and overtreatment can be avoided.”