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Prostate screening an individual decision for men over 55, panel says

A panel of experts on Tuesday updated its prostate cancer screening guidelines, recommending the test should be an individual decision for men between age 55 and 69 and advising men older than 70 skip it altogether.

The United States Preventive Services Task Force revised its recommendation from 2012, which discouraged prostate-specific antigen screening for men of all ages, regardless of family history or race. This was based on grade D evidence suggesting that the harms of testing outweigh the benefits.

But now the panel says there is grade C evidence of "moderate certainty" of a "small potential benefit of reducing the chance of death from prostate cancer in some men."



"For men aged 55 to 69 years, the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one and should include discussion of the potential benefits and harms of screening with their clinician," the USPSTF said in the new guidelines.

Prostate cancer is the most common cancer among American men with about 164,690 new cases of prostate cancer and is the second-leading cause of death -- 29,430 each year -- behind lung cancer, according to the American Caner Society. And about 1 in 9 men will be diagnosed with prostate cancer during a lifetime.

In a paper paper published Tuesday in the Journal of the American Medical Association, the authors said screening may prevent 1.3 prostate cancer deaths per 1,000 men screened over 13 years and prevent 3 cases of metastatic prostate cancer.

The advisory panel noted drawbacks to the screening, including the potential for false-positives that require additional testing, such as prostate biopsy, overdiagnosis, overtreatment and complications that can include incontinence and erectile dysfunction.

The panel said patients and clinicians should weigh benefits and harms on the basis of family history, race/ethnicity, patient values about the benefits and harms of the process and other health needs. The lowered recommendation includes African-American men and men with a history of prostate cancer.

In a D recommendation, USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older.

"Adequate evidence shows that the harms of screening in men older than 70 years are at least moderate and greater than in younger men because of increased risk of false-positive results, diagnostic harms from biopsies and harms from treatment," USPSTF said.

The final recommendations are in line with other groups' recommendations of the choice by the American Cancer Society, the American College of Physicians, the American Society of Clinical Oncology and the National Comprehensive Cancer Network.

The American Urological Association, in a statement, said it "commends" the new guidelines for men 55 to 59, but opposes the change for men over 70.

"While we agree that a number of older men are not candidates for prostate cancer testing, we believe that select older, healthier men may garner a benefit. We urge those men to talk with their doctors about whether prostate cancer testing is right for them," AUA President Dr. J. Brantley Thrasher said in a statement.

By Allen Cone

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