Physicians have been walking this tightrope since they began regularly using PSA tests to screen for prostate cancer in healthy men in the 1990s.
There is no other test that effectively screens for prostate cancer — the second deadliest cancer for American men, oncologists said.
It concluded that men screened with PSA tests were no less likely to die of prostate cancer than men assigned to a group that was not screened.
He has pushed to rename early-stage prostate cancer in part to ease the stress of a cancer diagnosis.
A new approach to prostate cancer screening emerges Dr. Tyler Seibert, a radiation oncologist and associate professor at the University of California, San Diego, is not as optimistic about eliminating prostate cancer.
Long-standing concerns regarding the advantages and disadvantages of a blood test that checks for the most common cancer among men in the United States have been rekindled by the news that former President Joseph Biden has advanced prostate cancer. S. .
According to medical professionals and public health experts, PSA screening tests are not a perfect way to identify prostate cancer.
Detecting and treating aggressive cancers like Biden’s without needlessly treating men with slow-growing cancers that are unlikely to make them ill is part of the issue. According to autopsies, the disease was so common that half of Black men in their 70s and more than one-third of white men had prostate cancers that would never cause any harm.
Radiation oncologist Dr. Brent Rose, an associate professor at the University of California, San Diego School of Medicine, stated that “PSA testing alone leaves a lot to be desired as a cancer screening test.”.
The test determines the blood’s concentration of PSA, a protein made by both healthy and cancerous prostate gland cells. PSA elevation may indicate cancer. It can also indicate an inactive cancer or a false positive, which would result in a painful biopsy and overtreatment with punishing side effects like bowel dysfunction, incontinence, and impotence.
Rose stated, “PSA screening is beneficial.”. However, there are risks, so whether or not to do PSA screening is a personal choice. “.
Rose and other oncologists told NPR that the goal is to prevent and treat aggressive cancers while monitoring and treating cancers that may never become problematic. Since the PSA test was first routinely used in the 1990s to screen for prostate cancer in healthy men, doctors have been balancing this tightrope. According to oncologists, prostate cancer is the second most deadly cancer for men in America, and there is no other test that can detect it.
a past of contradictory advice.
Public health recommendations on PSA screening have been inconsistent and unclear for the past 20 years as a result of attempts to weigh the potential risks against the number of lives saved. In 2012, the U.S. S. . The Preventive Services Task Force recommended against screening altogether, but in 2018 they issued a weakened recommendation that men between the ages of 55 and 69 talk to their healthcare providers about screening. Different medical associations provide contradictory advice for this age group.
However, in its guidance for senior men, the U. S. There has been a little more consistency from the Preventive Services Task Force. The independent panel of national experts advised against screening men 75 and older in 2008, and they have continued to advise against screening men 70 and older since 2018.
The 82-year-old Biden reportedly complied with the directive. According to a spokesperson, he last underwent a PSA screening test in 2014, at the age of 71 or 72.
Before choosing to have a PSA test, the task force advises men aged 55 to 69 to discuss their preferences with their healthcare providers. The recommendation is categorized as Grade C, meaning that insurers might not cover it and that it provides very little benefit.
Oncologists interviewed for this story said it can be difficult for most primary-care physicians to find the time to talk about a complex issue like the importance of prostate-cancer screening. As for “shared decision-making,” some men may embrace it, but others find it excruciating. For now, the only recommendation for men is to carefully discuss the matter with their physicians.
PSA test justification.
Dr. As the task force drafts new guidelines, Alicia Morgans, a genitourinary medical oncologist at the Dana-Farber Cancer Institute in Boston, acknowledges the issue and hopes that it will be addressed. She met with the volunteer panel in August while serving as the chair of the Zero Prostate Cancer advocacy group’s medical advisory board.
Morgans thinks a faulty clinical trial served as the foundation for the current guidelines. It came to the conclusion that men who underwent PSA testing had the same risk of dying from prostate cancer as men in the unscreened group. However, she noted that nearly 90% of the men in the control group had at least one PSA test prior to or during the trial, clouding the results.
Morgans would like to see the recommendation strengthened to encourage more men to get screened for prostate cancer and to encourage earlier screening of more vulnerable men, such as Black men and men with a family history.
She stated, “I treat patients with both very advanced prostate cancer and some with curable prostate cancer, so my perspective is really skewed by the fact that I really want to make that diagnosis when things are curable.”. “..”.
Dr. Matthew Cooperberg, a professor at the University of California, San Francisco and a urologic oncologist, agrees. To lessen the anxiety associated with receiving a cancer diagnosis, he has advocated for the renaming of early-stage prostate cancer. An aberrant growth without the capacity to spread or kill is referred to as an “acinar neoplasm,” among other names. Cooperberg also advises waiting to perform a prostate biopsy on men who have elevated PSAs.
He stated that “in order to detect aggressive prostate cancer, men should have PSA testing done in midlife.”. “We should avoid treating any low-grade disease we discover along the way, whether or not it is classified as cancer. We simply keep an eye on it through active surveillance. We can eradicate this cancer if we do that. “..”.
Prostate cancer screening takes a new turn.
Doctor. Radiation oncologist Tyler Seibert, an associate professor at the University of California, San Diego, is less hopeful about the eradication of prostate cancer. However, he is also committed to identifying and treating only the bad prostate cancers.
He claimed that when physicians initially started using PSA screening tests, “there was a flawed assumption that was implicit that if you find any kind of prostate cancer, you must treat that kind of prostate cancer aggressively,” he said. The patient would never have suffered any harm from many of them. “.”.
According to Seibert, a new era in prostate cancer screening has begun. These days, he and a growing number of prostate-cancer specialists advise men who receive an elevated PSA test to first get an MRI and, if at all possible, watch and wait before having their prostates biopsied.
He said, “We have really strong evidence that we can follow these patients closely, and they basically can just carry on with their life, for these patients with low-risk prostate cancer.”.
Seibert admitted that not everyone feels comfortable having routine blood tests to check if their PSA is rising and they may need cancer treatment. However, he stated that the majority of his patients do get used to the procedure.
“You get a little anxious every time you get that blood test,” he said. Screening makes a lot of sense if you can handle that and don’t anticipate experiencing excessive anxiety as a result. “.
Ronnie Cohen is a San Francisco Bay Area-based freelance health journalist.
