A US government advisory panel has reversed its opposition to a controversial prostate cancer screening test for men aged 55 to 69, saying it could slightly reduce the mortality rate, according to draft recommendations published on Tuesday.
Patients are now advised to discuss the potential benefits and harms of prostate-specific antigen (PSA)-based screening with their physicians and then decide individually whether it's the best route, the US Preventive Services Task Force said in its guidance published in the Journal of the American Medical Association.
PSA-based screening tests for a protein in the blood that is produced by the prostate gland. An elevated level can indicate a cancerous tumor but also signal benign conditions. A normal PSA level does not always rule out the presence of cancer.
"The decision about whether to be screened for prostate cancer should be an individual one," the task force said in its recommendation, which will be open to public comment until May 8 before being formalized.
The stance marks a reversal from the panel's recommendation in 2012, when it concluded that the adverse effects of the blood test outweighed its benefits.
PSA screening can result in a high percentage of false positives, and aggressive treatment of slow-moving tumors -- which don't pose a significant threat to the patient's health -- can have potentially serious side effects such as incontinence and impotence.
The latest recommendation says that overall, PSA-based screening for men aged 55 to 69 "offers a small potential benefit of reducing the chance of dying of prostate cancer."
For men 70 and older, the advisory panel continues to recommend against PSA-based testing, arguing that for this age group, prostate cancer evolves slowly and the 10-year survival rate is relatively high.
- Better surveillance -
The government task force found that a newer approach, known as "active surveillance," reduced some of the harms associated with treatment.
Men diagnosed with lower-risk prostate cancer are monitored with more frequent PSA testing and prostate biopsy rather than immediate surgery or radiation.
Such an approach reduces the risk of aggressive treatments, which are reserved for cases where the cancer progresses.
More than 161,000 men in the United States will be diagnosed with prostate cancer in 2017, according to the American Cancer Society and nearly 27,000 will die at an average age of 80.
African-American men and men with a family history of prostate cancer are more at risk of developing the disease.
Nearly three million Americans live with prostate cancer, and many patients undergo surgery or radiation after diagnosis.
But several studies published at the end of last year concluded that the survival rate for a man with early stage prostate cancer is 99 percent ten years after diagnosis, regardless of whether the patient's treatment was surgery, radiation or active surveillance.
The new recommendation from the USPSTF is the latest chapter of a long debate over PSA-based prostate cancer screening.
Urologists had criticized the panel's 2012 advice against the testing, saying such an approach would lead to a reduction in screening and an increase in deaths.
However, other medical groups such as the American Cancer Society have been more nuanced, continuing to recommend regular PSA testing while urging patients and their physicians to discuss the benefits and risks.
The American Urological Association on Tuesday praised the new guidelines as "thoughtful and reasonable."
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