PROSTATE CANCER SCREENING - U.S. Preventive Services Task Force recommendationsPROSTATE CANCER SCREENING - U.S. Preventive Services Task Force data for recommendationsAttached in the link is the data by Chou et al in the Annals of Internal Medicine, the basis of which the U.S. Preventive Services Task Force has made their recommendations against the use of PSA testing as a means of prostate cancer screening.
This clearly means that there is no evidence to support mass, population-based PSA screening for risk of prostate cancer.
BUT this does not necessarily imply opposition to the use of this test in selected, healthy individuals after discussion with their physicians.
Note the discussions in the linked article on the following:1. Does PSA-based screening decrease prostate cancer–specific or all-cause mortality?
2. What are the harms of PSA-based screening for prostate cancer?
3. What are the benefits of treatment of early-stage or screening-detected prostate cancer?
4. What are the harms of treatment of early-stage or screening-detected prostate cancer?
Also note the following:(a) The number of men needed to be screened to prevent one death from prostate cancer during prostate cancer screening was 1,410
(b) The advocates for mass screening constantly neglect the fact that 83% of men are at absolutely no risk for clinically significant prostate cancer in their lifetime
(c) Extensive data from Vickers, Lilja and others suggesting that a man with a PSA test result of less than about 0.7 ng/ml at about the age of 40 is at low risk for clinically significant prostate cancer, whereas a man with a PSA test of > 0.7 is at higher risk for clinically significant disease over the next 25 to 30 years. This information, combined with family history and ethnicity, potentially offers a methodology for risk-based PSA testing over time
This recommendation may help the following:(a) Men who have an elevation in their PSA at age 75 to not have a biopsy that they don’t really need.
(b) Help those who have a diagnosis of low-risk prostate cance between the ages of 50 and 75 years to decide that active surveillance is wiser than immediate surgery.
(c) Help men in their late 70s or 80s to decide that at their age PSA testing is a complete waste of their time because their chances of a prostate cancer-specific death are already near to negligible.
(d) A more selective PSA screening for high-risked individuals, and PSA evaluation in mid-life in forecasting the future risk of prostate cancer
Also in the following link just below is the Catalona's NEJM 1991 article on the PSA test:“The value of screening for prostate cancer is controversial. There is concern about whether screening tests will detect the so-called latent prostatic cancers that exist in approximately 30 percent of men over the age of 50. Most of these tumors cause neither morbidity nor mortality”.
The Catalona link is below:http://www.nejm.org/doi/full/10.1056/NEJM199104253241702#t=articleTopThe data by Chou et al in the Annals of Internal Medicine on the U.S. Preventive Services Task Force recommendations is in the attached link:http://www.annals.org/content/early/2011/10/07/0003-4819-155-11-201112060-00375.fullRgds,
Rajeen
Source:
PROSTATE CANCER SCREENING - U.S. Preventive Services Task Force recommendations
