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.
Longstanding 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 specialists, PSA screening tests are not a perfect way to identify prostate cancer.
Finding 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. Over one-third of white men and half of black men in their 70s had prostate cancers that would never cause any harm, according to autopsies, which revealed how common the disease was.
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. A higher PSA may indicate cancer. Additionally, it may indicate a false positive or an inactive cancer, which would necessitate a painful biopsy and result in overtreatment with punishing side effects like bowel dysfunction, incontinence, and impotence.
Rose stated, “PSA screening is beneficial.”. It is up to the individual to decide whether or not to undergo PSA screening because there are risks involved. “.
According to Rose and other oncologists who spoke to NPR, the goal is to identify and treat aggressive cancers while simultaneously monitoring and treating cancers that may never become problematic. Since the 1990s, when PSA tests were first routinely used to screen healthy men for prostate cancer, doctors have been operating on a tightrope. Prostate cancer, the second most deadly cancer for American men, cannot be detected by any other test, according to oncologists.
a past with contradictory instructions.
For the past 20 years, public health guidelines regarding PSA screening have been inconsistent and unclear due to attempts to weigh the potential risks against the number of lives saved. 2012 saw the U.S. S. . After advising against screening altogether, the Preventive Services Task Force in 2018 issued a weakened recommendation that men between the ages of 55 and 69 talk to their healthcare providers about screening. There are differing recommendations for this age group from different physician associations.
But in its guidance for senior men, the U. A. There has been a little more consistency from the Preventive Services Task Force. An independent panel of national experts advised against screening men 75 and older in 2008, and since 2018, the panel has recommended against screening men 70 and older.
Biden, 82, reportedly complied with the advice. According to a spokesman, he last underwent a PSA screening test in 2014, at the age of 71 or 72.
Before deciding whether to get a PSA test, the task force advises men between the ages of 55 and 69 to discuss their preferences with their healthcare providers. It assigns the recommendation a Grade C rating, meaning that insurers might not cover it and that it provides very little benefit.
For most primary-care physicians, it can be difficult to find the time to talk about something as complex as the importance of prostate-cancer screening, according to oncologists interviewed for this article. Furthermore, although some men may embrace “shared decision-making,” others find it excruciating. For the time being, the only recommendation for men is to carefully discuss the matter with their physicians.
The PSA test’s case.
Doctor. Genitourinary medical oncologist Alicia Morgans of the Dana-Farber Cancer Institute in Boston acknowledges the issue and hopes the task force will address it in the new guidelines it is currently developing. 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. The study 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. She claimed that nearly 90% of the men in the control group had at least one PSA test prior to or during the trial, which clouded the results.
Morgans wants 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.
“My perspective is really skewed by the fact that I really want to make that diagnosis when things are curable,” she said, adding that she treats patients with both very advanced prostate cancer and some with curable prostate cancer. “.”.
So does Dr. Matthew Cooperberg, a professor at the University of California, San Francisco and urologic oncologist. He has advocated for the renaming of early-stage prostate cancer, partly to alleviate the anxiety associated with receiving a cancer diagnosis. One term, “acinar neoplasm,” could be used to describe an aberrant growth that has no capacity to spread or cause death. Cooperberg also suggests that men with high PSAs should be watched before having a prostate biopsy done right away.
He stated, “The purpose of PSA testing in midlife is to detect aggressive prostate cancer in men.”. “We shouldn’t treat low-grade diseases that we discover along the way, whether or not they are classified as cancer. We simply use active surveillance to keep an eye on it. This cancer can be eradicated if we take that action. “..”.
There is a new method for screening for prostate cancer.
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 figuring out how to recognize and treat only the bad prostate cancers.
He stated that “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” when physicians first started performing PSA screening tests. Many of them wouldn’t have hurt the patient at all. “,”.
According to Seibert, prostate cancer screening has entered a new era. He and a growing number of prostate-cancer specialists now advise men to get an MRI first and, if at all possible, watch and wait rather than having their prostates biopsied right away when they receive an elevated PSA test.
In his words, “We have really strong evidence that we can follow them closely, and they basically can just carry on with their life,” for patients with low-risk prostate cancer.
According to Seibert, not everyone feels comfortable having routine blood tests to check if their PSA is rising and they may need cancer treatment. According to him, however, the majority of his patients do get used to the procedure.
He remarked, “You’re kind of a little bit nervous every time you get that blood test.”. “Screening makes a lot of sense if you can handle that and don’t anticipate experiencing excessive anxiety. “.”.
Based in the San Francisco Bay Area, Ronnie Cohen works as a freelance health journalist.
