You may have heard news regarding the use of PSA testing to screen for prostate cancer in men. In April 2017, the United States Preventive Services Task Force (USPSTF), a group of health experts who provide guidelines regarding preventive health care, released a draft recommendation statement that recommends for routine screening for prostate cancer with PSA testing.
The USPSTF issued this statement on its website:
"The Task Force continues to find that the potential benefits and harms of screening are closely balanced. To update this recommendation, we looked at new evidence that helps us better understand the potential benefits of prostate cancer screening. We also reviewed new evidence about the potential safety of active surveillance. Active surveillance has become a more common treatment choice for men with low-risk prostate cancer over the past several years, and may reduce the potential harms of screening in low-risk men who choose this option.
The new evidence and increased use of active surveillance convinced the Task Force to revise its recommendation for men ages 55 to 69. Today, the Task Force recommends that men consider both the potential benefits and harms and make an individual decision about whether to be screened, based on their values and preferences.The evidence continues to show that the potential benefits do not outweigh the harms of screening in men age 70 and older. The Task Force recommends against screening for prostate cancer in these men."
The prostate gland is an organ in men that resides in the region where the bladder empties into the tube that drains urine from the body. Cancer of this gland is one of the most common for men, and can lead to symptoms including frequent or difficult urination. However, many men have no symptoms at all.
Clinicians typically screen for cancer of the prostate by examining the gland on a yearly basis in men after age 50, and use PSA levels to look for evidence of cancer before signs or symptoms develop. If the PSA level is high, a prostate biopsy might be needed to see if cancer is actually present.
The PSA test, like many screening tests, is not 100% accurate. Therefore, some patients who test positive will undergo biopsy or even surgery that ultimately shows it was a false alarm.
Many men who test positive have cancer that is so slow growing that they would likely die of something other than the actual prostate cancer, and therefore would not require treatment. Presently, there is no simple way to tell which cases of prostate cancer are life-threatening and require treatment, and which cases are not.
Screening can have the unintended consequence of causing unnecessary worry and put men at risk for the adverse effects of treatment with surgery, radiation, or medications. Long term side effects can include incontinence and impotence. Of course, this has to be weighed against the possible benefits of detecting early prostate cancer.
Early detection and treatment of prostate cancer can be can curative, and can prolong cancer-free years of life. Studies have shown that having surgery for localized prostate cancer reduces the occurrence of metastasis (spread of cancer beyond the prostate gland), and as such can reduce the potential suffering associated with prostate cancer that progresses.
Additionally, a recent study in VA patients showed similar longevity when comparing men who had surgery for localized prostate cancer versus men who were simply observed. However, the men who had surgery were less likely to die from complications of prostate cancer.
At GreenField, we try to make it a priority to build strong relationships with our patients, and develop a trust between the patient and their physician or clinician that promotes shared decision making. Each patient should base decisions about PSA screening on their overall health, family history, and how they weigh the benefits of detecting a potentially treatable cancer versus the risks of unnecessary procedures, surgery, and worry.
We invite each patient to have a personal discussion with their GreenField physician or clinician to explore these issues further. Our duty is to use the available evidence to advise each patient of his best medical interests, which remains the key to a strong doctor-patient relationship.