Recently, the U.S. Preventative Services Task Force revised its 2012 recommendations against routine prostate cancer screening for otherwise healthy men. The revamped 2017 guidelines now encourage conversation between patient and doctor regarding the specific pros and cons of undergoing testing -- including discussion on whether or not the benefit of testing will outweigh the potential risk. This is a decision that has many urological specialists, including me, encouraged. I know that prostate screening saves lives. It has the potential to detect prostate cancer in its early stages -- when the likelihood of curability is most possible.
When health care experts discuss most any type of cancer, we espouse the virtues of screening and early detection. Women, for example, are encouraged to be on the lookout for breast cancer by conducting monthly self-examinations of their breasts and having a breast exam performed at their yearly gynecologic appointment. This is with evidence-based reason. The earlier a cancer is detected, the more likely it can be treated effectively and often cured in its earliest stages. The new prostate cancer screening conclusion from the USPSTF is that the risks and benefits of such testing for prostate cancer are closely balanced, and men are now encouraged to speak with their doctors regarding the prostate-specific antigen, or PSA, blood test.
So what exactly is the PSA test? Prostate-specific antigen is a protein made by the prostate, and elevated levels of this serum in the blood can be an indicator of prostate cancer, which is a helpful marker in identifying cancer in its earliest stages. However, an elevated PSA level is not a definitive cancer diagnosis in and of itself. Other testing, like ultrasound or biopsy, is required to arrive at a prostate cancer diagnosis.
The 2017 prostate cancer screening guidelines encourage dialogue between patient and provider. Men of average health between the ages of 55 to 69, plus younger men who have a family history of prostate cancer or are of African American descent, are highly urged to speak with their doctor for further guidance and testing recommendations. The only population that should not be routinely screened, according to the USPSTF, is men over the age of 70 due to prostate cancer being a generally slow-growing disease. For these men, it's thought their lives may end due to other natural causes before the cancer was around long enough to spread.
So why the new guidelines? After much scientific scrutiny and based upon new findings on the effectiveness of PSA testing in clinical trials, PSA screening is proven to be capable of saving lives. The report shares that for every 1,000 men, two to three lives could be saved. Alternately, the previous recommendations in 2012 reported no evidence that the benefits of the test outweighed the consequences. You're probably wondering, what consequences are they referring to? How could a blood test be harmful?
The blood test itself had no direct physical consequences on the men. However, receiving PSA results indicative of cancer was believed to lead to a higher volume of premature diagnoses and aggressive treatments. But thanks to the recent initiation of "active surveillance" or "watchful waiting," the risk of jumping into unnecessary treatment has been significantly reduced. What is active surveillance? It simply involves regularly repeated PSA tests and very closely monitoring (surveillance) of the patient by the doctor. Carrying out this non-invasive treatment option allows more men to live more years without unnecessary treatment and potential side effects, while still keeping a watchful eye so that the potential development of prostate cancer can be caught as soon as possible.
[See: How to Be a Good Patient Wingman.]
I am pleased to see that the USPSTF panel experts are now more confident of the benefits of prostate cancer screening. But perhaps most importantly, it's encouraging to see patients having more autonomy over their health care decisions and deciding for themselves if they want to get tested. Each and every patient's specific situation is different, and through discussions with and recommendations from a trusted health professional, they will be able to ultimately make the decision that's right for them.
S. Adam Ramin, M.D., is a board-certified urologist and founder and medical director of Urology Cancer Specialists in Los Angeles. He is on staff at prestigious medical centers such as City of Hope National Medical Center and Cedars Sinai Medical Center in Los Angeles, where he performs robotic laparoscopic prostatectomy. As an expert in prostate cancer and robotic laparoscopic prostatectomy, Dr. Ramin has published numerous peer review articles and research papers on prostate cancer. He has trained numerous urologists in techniques of minimally invasive laparoscopy and robotic surgery. Dr. Ramin has performed over 1,500 laparoscopic and robotic procedures for prostate, kidney and bladder cancers, and he provides patients curative surgery that is extremely precise, preserves sexual function, has minimal blood loss, minimal pain and quick recovery. Visit his website or connect with him on Facebook or Twitter.