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PSA should not be used for prostate cancer screening in healthy men

Discussion in 'Oncology' started by Egyptian Doctor, Oct 19, 2011.

  1. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

    Mar 21, 2011
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    The US Preventive Services Task Force (USPSTF) has recommended against prostate-specific antigen (PSA) screening for prostate cancer, saying it does more harm than good.

    The Draft Recommendation Statement applies to men in the US population that do not have symptoms that are highly suspicious for prostate cancer, regardless of age, race, or family history.

    Of note, the Task Force did not evaluate the use of the PSA test as part of a diagnostic strategy in men with symptoms that are highly suspicious for prostate cancer, nor did they consider the use of the PSA test for surveillance after diagnosis and/or treatment of prostate cancer.

    "The common perception that PSA-based early detection of prostate cancer prolongs lives is not supported by the scientific evidence," write the group's chairperson Virginia Moyer (Baylor College of Medicine, Houston, Texas) and colleagues.

    The Task Force reviewed prostate cancer screening studies for reductions in either prostate cancer deaths or overall mortality but found no mortality benefit for screening in men aged 70 years and older. Furthermore, for men aged 50 to 69 years, the evidence showed that the reduction in prostate cancer mortality 10 years after screening was "small to none".

    Indeed, 95% of men with PSA-detected cancer who were followed for 12 years did not die from that cancer, even in the absence of definitive treatment.

    The largest European trial that the team reviewed found a statistically insignificant 0.06% absolute reduction in prostate cancer deaths for men aged 50 to 74 years, while the largest US trial reported a statistically insignificant 0.03% absolute increase in prostate cancer deaths among men who received screening.

    The draft statement also points out that PSA-based screening is frequently associated with harm to the patient.

    "The harms of PSA-based screening for prostate cancer include a high rate of false-positive results and accompanying negative psychological effects, complications associated with diagnostic biopsy, and, most importantly, a risk for overdiagnosis coupled with overtreatment," write the authors

    "Depending on the modality employed, treatments for prostate cancer carry the risk of death, cardiovascular events, urinary incontinence, impotence, and bowel dysfunction," they add.

    Although the USPSTF discourages the use of screening tests for which the benefits do not outweigh the harms in the target population, it recognizes that some men will continue to request screening.

    These men should be allowed to make an informed decision about screening, preferably made in consultation with a regular care provider. "No man should be screened without his understanding and consent; community-based and employer-based screening that does not allow an informed choice should be discontinued," state the authors.

    Based on the available evidence "the USPSTF concludes with moderate certainty that PSA-based screening for prostate cancer, as currently utilized and studied in randomized, controlled trials, has no net benefit."

    In response to this statement the American Urological Association (AUA) said they are "concerned that the Task Force's recommendations will ultimately do more harm than good to the many men at risk for prostate cancer."

    "The AUA's current clinical recommendations support the use of the PSA test, and it is our feeling that, when interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging or risk assessment, and monitoring of prostate cancer patients," said AUA president Sushil Lacy (University of Nebraska, Omaha).

    He added that the AUA is currently preparing a new clinical guideline that will review the use of the PSA test, early detection of prostate cancer overall, and the use of new tests and diagnostics that are becoming available.

    Source : MedWire News - Most Popular Stories - PSA should not be used for prostate cancer screening in healthy men

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