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Nov.-Dec. 2011, Vol. XXVI, No. 6
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Managing your Health
Prostate cancer screening for healthy men?

In its October, 2011 draft statement, the U.S. Preventive Services Task Force (USPSTF) recommends against the use of prostate specific antigen (PSA) to screen asymptomatic men for prostate cancer. The USPSTF is an advisory panel which makes recommendations regarding preventive services for healthy people.

The PSA draft recommendation applies to men with no signs or symptoms of prostate cancer, regardless of age, race or family history. It does not apply to use of PSA as a “diagnostic strategy in men with highly suspicious symptoms for prostate cancer” or as a periodic surveillance test once prostate cancer has been diagnosed.

PSA is a protein made nearly exclusively by the prostate gland, and elevated levels may indicate the presence of prostate cancer. A prostate gland biopsy in which small pieces of tissue are removed and examined confirms the diagnosis.

But in its “benefits-harms” analysis the USPSTF says PSA-based screening “is associated with small to no reduction in prostate cancer-specific mortality after about 10 years and potential harms related to both ‘true positive’ and ‘false positive’ test results.”

The group’s draft recommendation has no force of law, but it does focus a bright light on preventive medical procedures. This happened when the USPSTF said women in their 40s should no longer get routine mammograms.

The mammogram recommendation triggered widespread debate. This PSA screening recommendation promises to do the same, as it differs from those of other highly respected organizations like the American Urological Association, American Cancer Society, American College of Physicians and the American College of Preventive Medicine. Readers should direct PSA screening questions to their healthcare providers.

Details of USPSTF recommendation
Referring to several extensive European and U.S. studies of PSA screening for prostate cancer, the USPSTF says in its draft report, “The evidence is convincing that for men aged 70 years and older, screening has no mortality benefit. For men aged 50 to 69 years, reduction in prostate cancer mortality 10 years after screening is small to none.”

The report says “PSA-based screening leads to substantial over-diagnosis.” This is of “particular concern because a high percentage of men are treated at the time of diagnosis” and may suffer impotence, incontinence or other complications.

Many groups including the American Cancer Society suggest each man discuss his own individual circumstances with a doctor.

This can be your regular doctor who has no specialty practice but can be a good source of independent advice. Depending on your medical situation, “watchful waiting” may be an option, since so many prostate cancer tumors grow very slowly.

Meanwhile, when people become Medicare-eligible, they are covered by a “Welcome to Medicare” physical exam that can include PSA-based prostate cancer screening for men who want it.

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