New take on prostate-cancer screening

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In April 2017, a U.S. Preventive Services Task Force (USPSTF) panel proposed new guidelines to determine whether a man should have a prostate-cancer screening. The panel slightly increased its support of prostate-specific antigen (PSA) screenings for men of certain ages.

Instead of recommending against a PSA screening for all men, the panel amended its guidelines to say that the decision regarding whether to give a PSA screening to men who are ages 55–69 should be based on their preferences and their doctor’s recommendation. For men who are ages 70 or older, the panel continues to recommend against a PSA screening; it believes that the harms outweigh the potential benefits, which was its conclusion previously for the 55–69 age group.

Dr. Adam Ramin of Urology Cancer Specialists says the proposed guidelines are warranted, because the recent adoption of “active surveillance” or “watchful waiting” practices significantly reduces the risk that a doctor will press a patient to get unnecessary treatment, including surgery. Dr. Kirsten Bibbins-Domingo, who is a member of the USPSTF panel, corroborates that view.

Dr. David Shusterman of New York Urology, who is a proponent of prostate-cancer screenings, believes that the proposed guidelines are improved but still fall short, because the USPSTF panel still recommends against PSA screenings for men who are older than 70, even though it admits that PSA screenings increase life expectancy. He also was critical that the panel lacked urologists.

Bibbins-Domingo says urologists were consulted during the panel’s initial draft of its new guidelines.

Shusterman contends that the panel’s focus is to save the government the costs that come from providing Medicare coverage for PSA screening, rather than men’s well-being. Bibbins-Domingo says the panel never considers costs or insurance coverage in its recommendations. She adds that since the Affordable Care Act was implemented, insurers have covered PSA screenings.

About 20 percent to 50 percent of men who underwent a PSA screening were treated for prostate cancer that wouldn’t hurt or kill them, Bibbins-Domingo says. The panel’s recommendations also take into account that three-fourths of men who undergo common treatments experience impotence or incontinence, she says.

Bibbins-Domingo expects the guidelines to be finalized in about 6 months.

—C. Maynard