New guidelines for use of PSA testing for prostate cancer diagnosis

New guidelines for use of PSA testing for prostate cancer diagnosis

Medical experts now say conventional prostate cancer screening can't tell the difference between aggressive cancer and more benign conditions.

Doctors with the US Preventive Services Task Force say the default PSA test for prostate cancer comes with risks.

“It's not a great test and part of the reason it's not a great test is because there are many things that can cause the PSA to rise,” said task force chair Dr. Kirsten Bibbins-Domingo. “Since many men are treated when they get the diagnosis of prostate cancer, the over-diagnosis can lead to over-treatment and then some of the harms of over-treatment like impotence and incontinence.”

Doctors have been using PSA tests to screen for prostate cancer since the early 1990s.

Bibbins-Domingo said deciding on whether to use the test is something men 54 to 69 should talk to their doctor about and weigh the benefits and risks of treatment.

“The challenge for PSA testing it doesn’t, it doesn’t’ help us distinguish aggressive cancers that we’re really concerned about from those that are slow-going and may not cause a man a problem during his lifetime,” she said. “Men should be aware of both benefits and harms. They should have a conversation with their doctor and basically make the best decision that is right for them after this conversation.”

An excerpt from the report:

The decision about whether to be screened for prostate cancer should be an individual one.

Screening offers a small potential benefit of reducing the chance of dying of prostate cancer. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; over-diagnosis and over-treatment; and treatment complications, such as incontinence and impotence. The USPSTF recommends individualized decision-making about screening for prostate cancer after discussion with a clinician, so that each man has an opportunity to understand the potential benefits and harms of screening and to incorporate his values and preferences into his decision.

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