Prostate cancer screening now recommended
A change in guidelines by the U.S. Preventive Services Task Force
The U.S. Preventive Services Task Force has finally given a passing grade of “C” for prostate cancer screening. The Task Force now concludes that “screening offers a small potential benefit of reducing the chance of dying of prostate cancer.” That is a notable change from their previous guidelines. In 2012 the USPSTF gave the prostate-specific antigen, or PSA, a grade of “D,” which meant that they “recommended against PSA–based screening for prostate cancer.”
Given the fact that black men are disproportionately impacted by prostate cancer, the 2012 guidelines were met with an uproar by health professionals and the African American community alike.
The PSA, a protein produced by the prostate gland, can be measured through a blood test. Elevated levels are often indicative of prostate cancer. The problem is that other conditions, such as an infection or enlarged prostate can elevate the protein as well.
An additional problem is that a universal acceptable level of the PSA protein is not known. At one time a reading above 4 would cause concern. It’s been found, however, that men with readings higher than four were clear of cancer, while some men with lower readings were afflicted. Some urologists prefer to look for increases in the levels over a period of time instead of reacting to one measurement.
Further muddying the situation is that a higher PSA – even if due to cancer – is not necessarily a death knell. Some prostate cancers are so slow growing that men die of other illnesses and not the cancer itself. Currently, doctors cannot predict the severity and aggressiveness of prostate cancer a man has. Because of this uncertainty, men can be subject to surgery, chemotherapy and radiation, thereby increasing the risk of impotence, infections and incontinence.
The USPSTF by no means gives a strong stamp of approval to PSAs. Its recommendation now is that men between the ages of 55 to 69 should be informed about the potential dangers and benefits of PSA-based screening. The Task Force still recommends against screening in men 70 years and older.
Not everyone agrees with these age limits. Excluding skin cancer, prostate cancer is the third most common cancer diagnosed, and accounts for 10 percent of all new cases a year. While one-third of new cases occurs between the ages of 55 and 64, almost 40 percent occur between the ages of 65 and 74, according to the National Cancer Institute. Another 20 percent of the cases strike men 75 and older.
That’s why the Society of Urologic Oncology recommends that men over age 70 should still be afforded the opportunity to be screened. Not only is prostate cancer common in this age group, it is more severe. Older healthy men with an expected additional ten or more years of life may continue to benefit from PSAs.
For reasons not understood, prostate cancer disproportionately impacts black men. While whites account for 122 new cases per thousand men, the number for blacks is 205 cases. Death rates are similarly dismal: 19 per 100,000 deaths in whites versus 44.2 in blacks.
In its updated guidelines, the USPSTF recognizes the severity of the situation for African Americans, but does not offer a specific protocol geared toward that population. That’s largely because of lack of the data to support such guidelines. Clinical trials for prostate cancer in this country and in Europe have consisted almost exclusively of white men.
The American Cancer Society, however, recommends that men of average risk should explore the risks and benefits of the PSA test at age 50 and at age 40 if they are of very high risk. Those in the latter category are black men and those with several first-degree relatives who had prostate cancer at an early age.
The bottom line is that males need to be aware of their risk of prostate cancer, talk to their doctor and act accordingly. Keep in mind that this is a potentially fatal disease.