Recommendation against PSA test goes too far: expert
(Medical Xpress) -- A draft recommendation by the U.S. Preventive Services Task Force calling for an end to routine PSA testing for healthy men age 50 and older goes too far, says a prostate cancer expert at the Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis.
Mass screening is not the way to go, says Gerald Andriole, MD, chief of urologic surgery, who acknowledges that widespread testing has lead many men with slow-growing tumors to be over diagnosed and over treated with aggressive therapies. We have to take a more nuanced approach to determine which men should be screened in the first place, how frequently they should be tested, and whether their cancer warrants therapy.
In recommending against routine PSA screening, the task force says that the test does not save lives and, when positive, often leads to invasive biopsies and treatments such as surgery or radiation therapy, with side effects that can include incontinence and impotence.
But Andriole, who also is the principal investigator of the National Cancer Institutes Prostate, Lung, Colorectal and Ovarian (PLCO) screening trial, argues that it would be a mistake to universally dismiss the PSA test. Rather, he says the decision to screen should be left up to patients and their doctors, who should take into consideration a mans overall health, age and other risk factors.
Discouraging men with a high risk of dying from prostate cancer particularly African-Americans and those with a family history of prostate cancer from getting a PSA test would be misguided, he adds.
For men who choose to have a PSA test, Andriole urges caution if the test is abnormal. Doctors, he says, often do not need to rush to perform biopsies or recommend aggressive treatments because most prostate tumors grow slowly. In many cases, active surveillance may be practical, which involves periodic PSA tests and biopsies to monitor tumor growth rather than opting for immediate aggressive treatment.
Ending PSA screening all together would mean a return to the pre-PSA era when about a third of prostate cancers were advanced and incurable at the time of diagnosis.
Preliminary results of the PLCO trial, published in 2009 in the New England Journal of Medicine, indicated that routine PSA screening does not reduce deaths from prostate cancer among men ages 55-74 who had been followed for up to 10 years.
But Andriole says that a close look at younger, healthy men in the study showed an improvement in prostate cancer mortality among those who had PSA tests and digital rectal exams. With longer follow-up, there may be additional benefit to screening for younger men and men who are known to have a high risk of dying from the disease. Updated results of the study are expected to be published later this year.
Routine annual PSA screening is not necessary for most men, Andriole says. But men with a high risk of dying from prostate cancer particularly African-Americans and those with a family history of prostate cancer should still be screened.
Prostate cancer is the second most common cancer among men, after skin cancer. In 2010, nearly 220,000 U.S. men received a diagnosis of prostate cancer and an estimated 32,050 died of the disease.
- Prostate specific antigen testing may be unnecessary for some older men Feb 20, 2009 | not rated yet | 0
- PSA levels accurately predict prostate cancer risk in African-American men Feb 24, 2009 | not rated yet | 0
- USA's largest ever prostate cancer screening program shows high compliance and consistent results Dec 15, 2008 | not rated yet | 0
- New prostate cancer test gives more accurate diagnosis Apr 06, 2011 | not rated yet | 0
- Early warning: PSA testing can predict advanced prostate cancer Feb 15, 2008 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Pressure-volume curve: Elastic Recoil Pressure don't make sense
May 18, 2013 From pressure-volume curve of the lung and chest wall (attached photo), I don't understand why would the elastic recoil pressure of the lung is...
If you became brain-dead, would you want them to pull the plug?
May 17, 2013 I'd want the rest of me to stay alive. Sure it's a lousy way to live but it beats being all-the-way dead. Maybe if I make it 20 years they'll...
MRI bill question
May 15, 2013 Dear PFers, The hospital gave us a $12k bill for one MRI (head with contrast). The people I talked to at the hospital tell me that they do not...
Ratio of Hydrogen of Oxygen in Dessicated Animal Protein
May 13, 2013 As an experiment, for the past few months I've been consuming at least one portion of Jell-O or unflavored Knox gelatin per day. I'm 64, in very...
Alcohol and acetaminophen
May 13, 2013 Edit: sorry for the typo in the title , can't edit I looked around on google quite a bit and it's very hard to find precise information on the...
Marie Curie's leukemia
May 13, 2013 Does anyone know what might be the cause of Marie Curie's cancer
- More from Physics Forums - Medical Sciences
More news stories
The use of a smartphone application significantly improves patients' preparation for a colonoscopy, according to new research presented today at Digestive Disease Week (DDW). The preparation process, which begins days in ...
Cancer 17 hours ago | not rated yet | 0
Research presented at Digestive Disease Week (DDW) explores new methods for managing digestive health through diet and lifestyle.
Cancer 17 hours ago | not rated yet | 1
A ground-breaking advance in colonoscopy technology signals the future of colorectal care, according to research presented today at Digestive Disease Week(DDW). Additional research focuses on optimizing the minimal withdrawal ...
Cancer May 18, 2013 | 5 / 5 (2) | 0
(HealthDay)—Concurrent use of two immune checkpoint antibodies—ipilimumab and nivolumab—may be effective for the treatment of advanced melanoma, according to a proof-of-principal study presented in ...
Cancer May 17, 2013 | not rated yet | 0
(HealthDay)—The risks of metastasis and death associated with cutaneous squamous cell carcinoma (CSCC) are low, but significant, and risk factors for poor outcome include tumor diameter, invasion beyond ...
Cancer May 17, 2013 | not rated yet | 0 |
Researchers at the University of Wisconsin have identified a potential new risk factor for obstructive sleep apnea: asthma. Using data from the National Institutes of Health (Heart, Lung, and Blood Institute)-funded Wisconsin ...
5 hours ago | not rated yet | 0 |
A new study looking at sleep-disordered breathing (SDB) and markers for Alzheimer's disease (AD) risk in cerebrospinal fluid (CSF) and neuroimaging adds to the growing body of research linking the two.
5 hours ago | 5 / 5 (1) | 0 |
In their quest to learn more about the variability of cells between and within tissues, biomedical scientists have devised tools capable of simultaneously measuring dozens of characteristics of individual ...
6 hours ago | 5 / 5 (1) | 0 |
Scientists at Johns Hopkins have turned their view of osteoarthritis (OA) inside out. Literally. Instead of seeing the painful degenerative disease as a problem primarily of the cartilage that cushions joints, ...
6 hours ago | 5 / 5 (2) | 0 |
Gourmands and foodies everywhere have long recognized ginger as a great way to add a little peppery zing to both sweet and savory dishes; now, a study from researchers at Columbia University shows purified components of the ...
5 hours ago | not rated yet | 0
The hunt for an HIV vaccine has gobbled up $8 billion in the past decade, and the failure of the most recent efficacy trial has delivered yet another setback to 26 years of efforts.
10 hours ago | not rated yet | 0