New prostate cancer screening guidelines called into question

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A national health advisory panel is recommending against using a common prostate cancer screening test in healthy men, a finding that Dana-Farber Cancer Institute prostate cancer experts view as misguided.

The United States Preventive Services Task Force reviewed data from five screening trials and concluded that prostate-specific antigen (PSA) testing, a widely used screening method, “results in small or no reduction in prostate cancer–specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary.”

The panel’s report has been published on the Annals of Internal Medicine's website.

“This is the wrong message at this point in time,” says Philip Kantoff, MD, director of Dana-Farber's Lank Center for Genitourinary Oncology. “The issues of PSA-based screening and treatment of early disease are complex. Multiple steps and multiple decision points are involved. The blanket statement of saying that PSA-based screening is of no value is the wrong message right now. Not every man should be screened and not every man who is diagnosed with prostate cancer needs to be treated.  Finding those who may benefit from screening and treatment is our focus.”

Prostate cancer is the most commonly diagnosed cancer, and second leading cause of cancer deaths, in men in the U.S. The American Cancer Society estimates that more than 240,000 cases of prostate cancer will be diagnosed in the U.S. this year and that the disease will cause nearly 34,000 deaths.

Although there are no national guidelines that recommend routine PSA screening, it is commonly used in men age 50 and older as part of their annual health physicals.

Kantoff says that PSA screening is not without its limitations. There are issues associated with the test’s sensitivity and specificity – as measured by the likelihood of a false negative or false positive finding – but he views the test as a useful screening tool when used appropriately.

“There is no question that we need to be more careful with whom we screen, and we need to recognize that not every man needs to be screened,” says Kantoff. Furthermore, he added, it is important to know when to stop screening, such as for men who have limited life-expectancy due to their advanced age or to serious health issues.

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