A federal task force has amended its controversial opposition to prostate cancer screening, issuing new guidelines today that recommend men 55 to 69 discuss with their doctors whether to undergo regular PSA (prostate-specific antigen) testing. Men over 70 who don’t exhibit symptoms can still skip the test.
The new draft guidelines are a departure from the U.S. Preventive Services Task Force’s 2012 opposition to prostate cancer screening at any age, a recommendation that led to far fewer screenings and diagnosis of prostate cancer.
Research showed that the number of men over 50 who were screened declined to 31 percent in 2013, the number diagnosed with prostate fell by 23 percent from 2008 to 2012, and the number treated fell by 42 percent between 2007 and 2012.
That's not as bad as it sounds. Despite reductions in screening, the number of men who have died from prostate cancer has also declined (see chart, below). Likewise, many men with early-stage tumors were spared the side effects of treatment, which can be devastating. In fact, a 2013 New England Journal of Medicine article reported that 15 years after diagnosis, 87 percent of men who underwent surgery and 94 percent of men who had radiotherapy were unable to achieve an erection. Overtreatment of early stages of the disease was the main reason the task force issued its 2012 recommendation.
In updating its recommendation today, the task force acknowledged the potential harms of overtreatment, while still advocating for “individualized decisionmaking” between a man and his doctor.
"For men who are more willing to accept the potential harms, screening may be the right choice for them," Dr. Alex H. Krist, a member of the task force and associate professor of family medicine and population health at Virginia Commonwealth University, told CNBC. "Men who are more interested in avoiding the potential harms may choose not to be screened.”
Prostate cancer remains the third leading cause of cancer deaths among men in the U.S. In 2017 the American Cancer Society estimates that at least 161,000 men will be diagnosed with prostate cancer and more than 26,000 men will die of the disease.
Here are three things you need to know.
1. Be aware of your risk factor.
Men who fall into one of these higher-risk groups should talk to their doctor about screening:
African American men are twice as likely to get prostate cancer, more likely to have an aggressive form of the disease and 2.4 times more likely to die from it. A forthcoming report from AARP's Public Policy Institute and OptumLabs recommends that future prostate screening guidelines consider race and ethnicity.
Men with a family history of prostate cancer who develop the disease are twice as likely to die from it.
Men who exhibit certain symptoms should see a doctor right away. These include difficulty urinating, including a slow, weak or interrupted urinary stream; a need to urinate more often, especially at night; blood in the urine or semen; and discomfort in the pelvic area or lower back, or bone pain.
Eric Klein, M.D., of the Cleveland Clinic, recommends a baseline PSA for all men at age 50, and for higher-risk patients at age 45. Klein says men with PSA levels below 0.7ng/mL at baseline can slide to one test every five years, and those 60 and older with levels of 2 ng/mL or lower might never need another test — as long as they remain symptom-free.
2. Four new tests can help.
Researchers have been searching for years for a test that will better predict whether a man with an elevated PSA level has cancer or whether the higher level is due to aging, infection or an enlarged prostate.
They now have four. A urine analysis called PCA3 looks for the presence of a specific prostate cancer gene. The test does not conclude whether a man has cancer but can give doctors more confidence than the PSA test in deciding whether to biopsy.
In a Prostate Health Index blood test, doctors look at three different components of PSA to determine whether the elevated level is due to infection, benign prostatic hyperplasia (BPH) or possibly cancer.
The OPKO 4Kscore blood test is similar but looks at four components, two of which, when elevated, can predict a man's risk of developing aggressive prostate cancer.
Finally, the mpMRI scan has been found to accurately diagnose aggressive tumors in 93 percent of those suspected of having prostate cancer, according to a study in the Lancet.
If any one of these tests comes out positive, the next step is usually a biopsy.
3. Active surveillance works.
Many experts believe that active surveillance — closely monitoring slow-growing cancers, rather than treating them immediately — is the best option for many men. Active surveillance includes periodic PSA tests, rectal exams, biopsies and MRIs to check for changes.
Surveillance seems safe in men with early-stage, nonaggressive cancer, a Gleason score of 6 or less, and rectal-exam results that show the cancer is confined to one lobe of the prostate, says Anthony D'Amico, M.D., of the Dana-Farber Cancer Institute.
If PSA or Gleason scores rise, your doctor may recommend more aggressive treatment.
This story was updated by Gabrielle Redford on April 11, 2017.