Since 2012, the American Cancer Society has been urging men at average risk, age 50 and older to be tested with the Prostate-Specific Antigen (PSA) serum test. However, new evidence has materialized that reveals the potential benefits of PSA testing in men 70 and older do not outweigh the harms, so these men should not undergo PSA screening.
Men are affected by prostate cancer more than any other type of cancer aside from non-melanoma skin cancer in the United States and the leading cause of cancer mortality in the Hispanic origin populations and among men of all races, according the Centers for Disease Control and Prevention (CDC). In 2013, 176,450 men were diagnosed with prostate cancer in the United States and 27,681 died from the disease.The U.S. Preventive Services Task Force believe that all men should be made aware of the benefits, decreases the risk of metastatic cancer and dying of prostate cancer, and the risks, overdiagnosis and overtreatment, associated with screening. While these benefits are extremely important, they only occur in a small number of men. Overtreatment with radiation and surgery can have critical side effects like incontinence and impotence.
The new evidence that materialized has made the Task Force more confident than ever with the benefits of prostate cancer screening. There is also new evidence on the use of active surveillance in men, who are at a low-risk for prostate cancer, which may aid in alleviating some of the harms in these men by permitting some men at low-risk to avoid or delay radiation or surgery.
In the Task Force’s new 2017 draft recommendation, men between the ages of 55 and 69 will be encouraged to make an individual decision whether or not be screened, but only after seeking the advice of their clinician. The potential benefits, along with the harms should be discussed during this conversation.
While prostate cancer screening may offer benefits, they are also connected with harms. Whether to be screened is a complex decision that should be contemplated by men, together with their clinician. Men between the ages of 55 and 69, who are prepared to accept the potential harms, PSA screening may very well be the proper choice. Men should not be screened, if they are more concerned about avoiding the potential harms than other factors. Men age 70 and older should not be screened, because the potential benefits do not outweigh the harms.
The authors noted that since several research gaps were identified during the recent study that further studies are required in three essential areas. First, to confirm whether African-American men receive similar benefits as men in the general population further studies are required, since there is a higher prevalence of prostate cancer in these men. The lack of research makes it difficult to confirm that prostate cancer screening would reduce the risk of dying from prostate cancer in these specific men. Further studies are also needed to explore the frequency of prostate cancer screening and if screening should begin at the age of 55 would it give additional benefits in African-American men.
Second, further research is required to help men, who have a family history of prostate understand how the harms and potential benefits of screening may vary in these men compared with the general population. Lastly, further research is needed to identify improved prostate cancer screening testing that could distinguish, which cancers will likely spread and be aggressive and which will not – or which prostate cancers are extremely slow growing and would remain asymptomatic.
They study was published online The JAMA Network on April 11, 2017.