Prostate cancer screening: Pros and cons of new recommendations

The PSA test, which measures the level of prostate-specific antigen in blood, has been controversial since its arrival in the late 1980s.

The U.S. Preventive Services Task Force, an independent panel, made a bold move in 2012 when it recommended against routine PSA testing and said it should be abandoned because it can lead to surgeries and biopsies that are unnecessary.

But the panel recently softened its stance, recommending the PSA screening test for men 55 to 69, adding that taking the test is still the patient’s choice.

Dr. Vipul Patel, a urologist and robotic surgeon at Florida Hospital Global Robotics Institute, discussed the pros and cons of the most recent recommendations.

What do you think of the task force’s most recent recommendations?

It’s a step in the positive direction. Prostate cancer still kills approximately 30,000 men each year in the U.S., and it remains the second-leading cause of cancer death in men after lung cancer.

The panels’ 2012 recommendation was surprising because there was a 40 percent reduction in death rate from prostate cancer since the PSA test became available in the 1980s. You can’t draw a direct link between PSA screening and the drop in cancer deaths, but during that period, the only thing that had changed was the arrival of PSA testing.

So what’s the controversy?

The panel looked at the overall prostate cancer data and said that PSA testing didn’t impact patients’ survival. Still, some cancer organizations didn’t abolish the screening after the panel issued its recommendation. They just limited the screening to certain populations at risk.

Are you expecting any negative outcomes from the 2012 recommendations?

A recent study showed that prostate cancer rates have leveled off, instead of continuing their steady decline in the past three decades. The study also showed that there are more new cases of late-stage prostate cancer, which could be because those cancers weren’t caught early.

I expect that now that the rates have stopped falling, they’re going to start increasing. We’re now going to start seeing the negative effects of recommendations from 2012.

What do you think of the new recommendations?

The recommendation is to do PSA screening in men between 55 and 69 years old. Now the question is why not screen men younger than 55? The panel said they didn’t include that group because they didn’t have the data.

Also, there’s some discussion that 69 is not an old enough age to stop PSA screening because men are now living longer.

In your office, what do you do when a patient has a high PSA score?

We take their history and physical. Then we repeat the PSA test. We also do 4Kscore Test, which is a newer version of the PSA test to see if the patient has a high-risk prostate cancer. An MRI also helps us figure out who needs a biopsy. High PSA levels are no longer the only indication for biopsy.

And what do you do when the patient is diagnosed with prostate cancer?

Not every patient with prostate cancer needs to be treated. A lot of men have slow-growing cancers and cancers that may never affect their lives. So instead of radiation or prostatectomy, we do active surveillance.

We check their PSA routinely and check their prostate via a rectal exam. Chances of surviving prostate cancer are high if it’s caught early.

What’s the bottom line for patients?

For the average male out there, the message is, if you’re over 50 years old, get PSA screening and get a rectal prostate exam. If you are an African American male and have a family history of prostate cancer then consider earlier screening. If you have doubts, talk to your doctor and make an informed decision. And remember that prostate cancer is still the second-leading cause of cancer death in men.