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Prostate Cancer Screening Guidelines Raise Men's Risks: Docs

Prostate Cancer Screening Guidelines Raise Men's Risks: Docs
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By    |   Thursday, 05 May 2016 03:28 PM

Federal health guidelines that recommend against prostate specific antigen (PSA) testing for most men should be reviewed and reversed in light of new research showing it is a life-saving procedure, a group of influential American doctors argues.

Medical evidence that has emerged since the U.S. Preventative Services Task Force's 2012 recommendations against routine PSA testing now shows that such screening can help reduce the number of fatal cases of prostate cancer, said the group of researchers from New York-Presbyterian and Weill Cornell Medicine.

In making the argument, presented in this week's New England Journal of Medicine, the researchers said the latest studies contradict the task force’s recommendations — which were based on an older landmark national study they said is flawed — and that the guidelines should be reviewed and reversed.

"We expect this article to have a profound impact on the debate over the value of PSA screening," said Dr. Jim Hu, director of the LeFrak Center for Robotic Surgery at New York-Presbyterian/Weill Cornell Medical Center and the Ronald Lynch Professor of Urologic Oncology at Weill Cornell Medicine.

"While there are risks of over-diagnosis and over-treatment associated with PSA testing, it can play an important role in preventing prostate cancer deaths as part of a personalized approach to cancer screening. We're going to have to reconsider this issue."

Prostate cancer is the second leading cause of cancer death among American men and the most common form other than skin cancer.

PSA tests measure antigens in the blood that are linked to prostate cancer, as well as benign conditions such as prostatitis. Since the introduction of PSA screening in the early 1990s, the United States has seen roughly a 50 percent reduction in the prostate cancer mortality rate.

But PSA screening is not foolproof and doctors have expressed concerns that prostate cancer was being over-diagnosed and over-treated, posing the risk of serious side effects, such as incontinence and impotence.

Federal officials recommended against PSA screening based on the results of the Prostate, Lung, Colorectal and Ovarian (PLCO) trial — a $400 million study sponsored by the National Cancer Institute. For the study, men who received PSA testing were compared to those who did not. Researchers concluded that there was effectively no difference in the death rate between the two groups and concluded PSA screening is ineffective.

But after examining the study's methodology, the New York-Presbyterian and Weill Cornell Medicine researchers found that 90 percent of the men researchers said had not received PSA testing actually had been screened, so the results are skewed.

"We demonstrate that the PLCO study did not compare a group of men who received PSA screening to a group of men who were not screened, but compared men who were screened to other men who were screened, and we should therefore reconsider any decisions based on the study," said lead researcher Dr. Jonathan Shoag.

The authors plan to discuss PSA screening at the annual American Urological Association meeting in San Diego on May 9, 2016.

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US guidelines that recommend against prostate specific antigen testing for most men should be reviewed and reversed in light of new research showing it is a life-saving procedure, a group of influential American doctors argues.
psa, prostate, cancer, screening, guidelines, wrong
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2016-28-05
Thursday, 05 May 2016 03:28 PM
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