The U.S. Preventive Services Task Force. Whew, that's a lot to say. Hard to have a conversation when your mouth is that full. But the Task Force, or USPTF, is worth talking about and is asking us physicians to do some talking too. In a draft recommendation, the USPTF is telling men between the ages of 55 and 70 to have a discussion with their physician. The conversation is all about the risks and benefits of having a Prostate Specific Antigen (PSA) blood test to screen for the possibility of prostate cancer. This recommendation is a change from the USPTF's 2012 recommendation that PSA testing should NOT be done in this age group. Why the change in the recommendation? Basically two reasons:
- Some newer studies suggest that PSA screening can save lives. These studies are a little muddy, but anecdotally, I can attest that since the fall off in PSA testing following the 2012 USPTF recommendation, I am seeing more prostate cancers presenting with aggressive features.
- There are changes in treatment options for men with low grade, low stage prostate cancer. These options can decrease the frequency of side effects (impotence, incontinence) in men being treated for prostate cancer. These men may now be eligible for protocols that involve "active surveillance," in which a urologist carefully monitors the patient, with no treatment unless and until there is evidence of cancer progression.
To me, these points confirm that the risk/reward consideration is in favor of testing. If you find yourself (or a loved one) involved in the PSA or No PSA discussion with your health care provider, I hope the conversation goes something like this:
You: I think I might want to have a PSA test.
Provider: There are risk and benefits. Having the test may let us give earlier treatment to a prostate cancer, but you may become incontinent or impotent.
You: I understand and I think it might help me to have the PSA test.
Provider: The test will not diagnose all cancers.
You: But it might diagnose mine. I think the PSA test is right for me.
Provider: You may wind up getting treated for a prostate cancer that would not have killed you.
You: But if I am diagnosed, I will have lots of options. That is better than not being diagnosed until it is too late.
Provider: There is no guarantee this will save your life.
You: I WANT MY PSA.
So have the conversation. Weigh the positives and negatives against your personal beliefs. I hope you choose to test, but no matter what your decision, or your PSA results, I hope your life is a long and healthy one. And if you think this is an important discussion for someone else you love, please forward this blog, share it on Facebook, or give it a retweet.
If you missed our remembrance of Max last week here it is http://www.chicagonow.com/downsize-maybe/2017/04/the-biggest-and-the-best-says-goodbye/
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