A straightforward blood test to ascertain apparently healthy men for hidden prostate cancer does more harm than good and shouldn't be a part of routine medical care. This is the ultimate suggestion from the United States Preventive Services Task Force (USPSTF), published today. History of Internal Medicine.
About half of men over the age of 40 get this test as a part of an everyday checkup. It measures the quantity of a protein called prostate-specific antigen, which is secreted by the walnut-sized prostate. A standard PSA level can indicate latent prostate cancer. But it may even be an indication of prostate infection, an enlarged prostate, and other problems. Hunting for hidden disease within the absence of any visible signs or symptoms known as screening.
Here's the duty force's evidence-based rationale for saying “no” to routine prostate cancer screening using the PSA test. For every 1,000 men, routine PSA testing:
- Prevents 0 to 1 death from prostate cancer.
- Identify 110 cases of prostate cancer (most of that are unlikely to affect health or longevity)
- Some treatments used for prostate cancer caused serious cardiovascular events (heart attack, stroke, deep vein thrombosis, or pulmonary embolism) in 3 men.
- Causes treatment-related erectile dysfunction in 200 to 300 men.
- Causes treatment-related urinary incontinence in 200 to 300 men.
Most men and their doctors would agree that the severe uncomfortable side effects of treatment for a life-threatening problem corresponding to lung cancer or pancreatic cancer are value tolerating. But many men whose prostate cancer is treated with PSA screening have tumors they'd otherwise never have noticed. These men will suffer more from prostate cancer treatment than from the cancer itself.
Controversial proposal
Although prostate cancer. as normally Growing slowly, it doesn't all the time occur. one An estimated 28,000 men Will die of prostate cancer this 12 months. It is the second leading reason for cancer death within the United States. Lung cancerThat will kill about 90,000 men this 12 months.
Proponents of routine PSA testing say the test saves lives. In a commentary In line with the USPSTF suggestion, latest prostate cancer experts say that detecting prostate cancer in younger men (ie, of their 40s or 50s), who can expect one other 30 years to live Can, is essential. As Dr. William Catalonia of Northwestern University, one among the commentators, told NPR, “If all PSA screening were stopped, thousands of men would needlessly develop and die from prostate cancer.” They also criticize the board's recommendations, and that PSA testing needs to be approved for high-risk populations, corresponding to men with a family history of prostate cancer or men of African descent.
Dr. Otis Brawley, chief medical officer of the American Cancer Society, believes the USPSTF got it right. He believes that greater than 1,000,000 American men “treated” unnecessarily of his prostate cancer over the past 20 years. Writing in support of the USPSTF recommendationhe points out.
Americans have been taught for many years to fear all kinds of cancer and that the very best strategy to take care of cancer is to seek out it early and treat it aggressively. As a result, many individuals have blind faith in early cancer detection and subsequent aggressive medical intervention each time cancer is found. The harms from screening and medical interventions are underappreciated.
Personal decisions
The USPSTF was asked to do some heartbreaking math: What is the associated fee of 1 prostate cancer death prevented?
For the person whose life it's, and their family, the reply is easy: priceless. The answer shall be different for men whose prostate cancer was identified through PSA testing, those that were unnecessarily treated for a cancer that never posed a threat to their health, and people who now have prostate cancer. May not be penile, requiring diapers or other aids to administer urinary incontinence. , or those with chronic bowel problems.
“I explain to my patients that getting a PSA test can be a treatment that will eliminate the cancer from their body, but it can cause erectile dysfunction and incontinence,” says Dr. Komaroff. “They often respond that the uncomfortable side effects are manageable. Cancer. Then I tell them that there's a very small likelihood that their cancer will actually spread and cause pain, but that That I don't have a test that may determine what the probability is. Some say take it out, but others say, 'Then we'll see.' I believe the patient must be involved within the PSA testing decision.
The USPSTF suggestion is not going to be the ultimate word on PSA testing. Men still have a selection.
I actually have been telling my doctor for years that I don't want this. If you do, confer with your doctor. But before you get your blood drawn, know that a high PSA could send you down a path of biopsy and treatment that would do more harm than good.