An influential federal task force has dropped its opposition to routine screening for prostate cancer and now says that men between the ages of 55 and 69 should discuss the test’s potential benefits and harms with their doctors and make decisions based on their own “values and preferences.”
“The decision about whether to be screened for prostate cancer should be an individual one,” the U.S. Preventive Services Task Force said in a draft recommendation issued Tuesday.
The statement marks a turnaround from the panel’s 2012 stance, which concluded that any potential benefit from the PSA (prostate-specific antigen) test was outweighed by possible harms. Those negatives include a high percentage of false positives as well as potentially devastating side effects from the aggressive treatment of slow-growing malignancies that might never pose a health threat. Surgery and radiation can cause urinary incontinence and sexual impotence.
The draft recommendation says that, on balance, screening provides a small benefit for men ages 55 to 69. New evidence “increases confidence” that the PSA test reduces the risk of dying of prostate cancer or developing advanced cancer that spreads beyond the prostate.
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In addition, the task force noted, an increasing number of men with low-risk cancer are opting for “active surveillance,” which involves regular PSA testing, repeated rectal examinations and biopsies rather than aggressive treatment. That approach reduces the risks of injury from overtreatment, it said.
Yet “the balance of benefits and harms is still close,” said Kirsten Bibbins-Domingo, an internist at the University of California at San Francisco and task-force chair. “This is not a recommendation that says men should go get screened. This is a complex decision. Some men will want to avoid the chance of dying of prostate cancer no matter what, while others, given the side effects, will not think the benefits are worth it.”
The panel’s shift is the latest chapter in a long saga over prostate-cancer screening. Its 2012 recommendation was criticized by some urologists, who warned that it would lead to decreased screening and increased deaths. The American Urological Association denounced the decision.
But while some groups still recommend regular PSA tests, many have tempered their views. The American Cancer Society, for example, endorses “shared decision-making” in which men and their doctors discuss the pros and cons. Otis Brawley, chief medical officer of the cancer society, said the new task-force recommendation was an important step and “would decrease confusion.”