Prostate screening: should you or shouldn't you?

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MHN commends the latest recommendation from the U.S. Preventative Services Task Force that urges men to talk to their healthcare providers about when, or if, they need to be screened for prostate cancer using the prostate-specific antigen (PSA) test.

And there can be downsides of screening, including false-positive results that require additional testing and prostate biopsy, overdiagnosis and overtreatment, and treatment complications like incontinence and impotence. It might also prevent 3 cases of prostate cancer that has already spread per 1,000 men screened.

"For men who are more interested in the small potential benefit and willing to accept the potential harms, screening may be the right choice for them", said Task Force vice chair Douglas K. Owens, MD, MS. "Men who place more value on avoiding the potential harms may choose not to be screened". Now, the USPSTF has issued a new statement updating its 2012 recommendations.

There are new guidelines this morning for prostate cancer screenings. Specifically, clinicians should inform their African American patients about their increased risk of developing and dying from prostate cancer, as well as the potential benefits and harms of screening.

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But there is no evidence that prostate cancer screening improves overall survival. The guidance doesn't apply to men younger than 55 because they are considered low risk.

Addressing men age 70 and above, Salvatore Giorgianni, PharmD, Senior Science Advisor to MHN stated, "The approach to screening men in later years should be more closely aligned with current life expectancy and adjusted every two to three years to reflect male life expectancy". The panel said that men aged 55 to 69 years should consult with their physicians to discuss the benefits and harms of getting a screening. Patients should consider their family history and medical conditions before agreeing to do a prostate screening.

Professor at Virginia Commonwealth University for family medicine and population health and USPSTF's vice chairman, Dr. Alex Krist, claims that the extended follow up of more than a decade in these surveys, which was not obtainable in 2012, added up greatly to the decision to change the suggestion.

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