When the influential U.S. Preventive Services Task Force recommended against routine screening for prostate cancer in 2012, many men were surprised, confused, or even angry. Some men followed the advice and stopped getting screened or didn’t start, while others ignored it.
Now the Task Force has changed its collective mind. It has revisited the subject, as it does every five years, and issued new draft guidelines that leave the decision about prostate cancer screening to individual men, ages 55 to 69, depending on their “values and preferences” and in consultation with their doctors.
It still recommends against screening men 70 and older. (Note: Prostate cancer screening means testing men without signs, symptoms, or history of the disease.)
The new guidelines align with those of the American Cancer Society, American Urological Association, and American Academy of Physicians, though those groups say the discussion about the pros and cons of screening should begin around age 50 or even 45 and that most men should stop at 75, which is what we have also advised.
Some groups, such as the American Academy of Family Physicians and the Canadian Task Force on Preventive Health Care, still recommend against routine screening.
In some ways, the Task Force is going back to its pre-2012 guidelines, which said there was insufficient evidence to recommend for or against screening.
Why the change?
The test measures blood levels of prostate-specific antigen (PSA), a protein produced by prostate cells. PSA testing has long been a contentious issue because, though it is likely to benefit some men, it’s not clear how many lives it actually saves.
Meanwhile, the risks are well known, including overdiagnosis, overtreatment, and the serious adverse effects that treatment may entail. Thus, experts have had difficulty in advising men about what to do.
The Task Force is changing course largely because it now sees the benefit/risk ratio somewhat more favorably. It says that while research is still inconsistent, longer-term follow-up data from a key European study strengthen the case that screening slightly reduces the risk of dying from prostate cancer.
It cites estimates that for every 1,000 screened men (ages 55 to 69) over a 10- to 15-year period, 240 will get a positive PSA result, leading to 100 positive biopsy results and ultimately one or two fewer deaths from prostate cancer.
In addition, the Task Force notes there are now better ways to reduce the potential harms. For instance, improvements in how PSA results are interpreted and utilized allow doctors to better predict which cancers will behave aggressively and spread and which don’t need to be treated.
What’s more, treatment options are now better and more clearly understood. Notably, recent studies have confirmed that active surveillance (also called watchful waiting) can safely allow most men diagnosed with less-aggressive prostate cancer to monitor it for years without rushing into treatment. More men are now opting for that, reducing the potential harms of unnecessary treatment.
PSA ups and downs
PSA is not a cancer test per se. Blood levels can rise as a result of a variety of prostate disorders—such as infection, benign enlargement, or cancer—or sometimes for no apparent reason.
The test, which is easy to do and inexpensive, was introduced in the 1980s to monitor men already diagnosed with prostate cancer. But doctors soon began using it to screen millions of healthy men.
Even though the PSA test can detect cancer early, that isn’t always a good thing. Age greatly increases the risk of prostate cancer—about 90 percent of cases are diagnosed in men over age 55, and 70 percent of deaths occur after age 75.
However, the great majority of prostate tumors, especially in older men, remain small, develop very slowly or not…