The advantages and disadvantages of PSA tests for prostate cancer for midlife and older men

News that former President Joseph Biden prostate cancer has advanced long -term questions about the benefits new life versus the damage of a blood test that screens for the Usually diagnosed cancer in men in the US

Prostate -specific antigenOr PSA, screening tests are an imperfect tool for detecting prostate cancer, doctors and experts in the field of public health.

Part of the problem is identifying and treating aggressive cancers such as those of Biden, while they do not treat unnecessary men with slow -growing cancers to make them sick. Autopsies found The disease to be so widespread that more than a third of white men and half of the black men in the 1970s had prostate cancer that would never damage.

“PSA tests only leaves much to be desired as a cancer screening test,” said radiation oncologist Dr. Brent Rose, associate professor at the University of California, San Diego, School of Medicine.

The test measures the level of PSA, a protein produced by both normal and malignant prostate gland cells in the blood. Increased PSA can be a marker for cancer. It can also indicate a false positive or inactive cancer, causing a painful biopsy and lead to over -treatment with punishing side effects, including impotence, incontinence and intestinal disease function.

“PSA screening is favorable,” said Rose. “However, there are risks, and so it is a personal decision to do PSA screening or not.”

The key is to direct and treat aggressive cancers while waiting and watching cancers that may never be difficult, Rose and other oncologists said to NPR. Doctors have been walking this cord since they started using PSA tests to screen on prostate cancer among healthy men in the nineties. There is no other test that effectively screens on prostate cancer – the Second deadliest cancer For American men, oncologists said.

A history of conflicting guidance

Attempts to balance the possible damage against the number of lives saved have led to it Fluctuate for two decades – And confusing – Public Health Guidelines on PSA screening. In 2012, the Task Force of the American preventive services advised against each screening, only to give a weakened recommendation in 2018 that men from 55 to 69 years of screening are discussing with their care providers. Various doctor’s groups offer conflicting guidance for this age group.

In his advice to older men, however, the American preventive services task force has been a bit more consistent. In 2008, the independent panel of national experts ordered that they are not screened from 75 years and older, and since 2018 the panel has advised to screen men aged 70 and older.

Biden, 82, apparently followed the guidance. He last had a PSA screening test in 2014, when he was 71 or 72 years old, a spokesperson said.

For men between 55 and 69 years old, the Task Force orders Talk to their care providers about their preferences before they decide if they should get a PSA test. It classifies the recommendation as class C, which means that it only offers a small advantage and insurers may not cover it.

Finding the time to have a conversation about a subject that is as complicated as the value of prostate cancer screening can be a challenge for most primary care doctors, according to oncologists who have been interviewed for this story. And although some men may welcome what ‘shared decision -making’ is called, others find it painful. Yet the only advice for men is currently to talk about the issue with their doctors carefully.

The case for the PSA test

Dr. Alicia Morgans, a urogenital medical oncologist at the Dana-Farber Cancer Institute in Boston, acknowledges the problem and hopes that the Task Force will tackle this in new guidelines that it is currently drawn up. In August she met the volunteer panel in her role as chairman of the Medical Advisory Board for the Advocacy group Zero Prostate Cancer.

Morgans believes that the current guidelines were based on a poor clinical study. It concluded that men who were screened with PSA tests are no less likely to die from prostate cancer than men assigned to a group that was not screened. But the results were muddy because almost 90% of men in the control group had at least one PSA test before or during the trial, she said.

Morgans would like the recommendation to be strengthened, so that more men are screened for prostate cancer and black men and men with a family history, which are more vulnerable, are screened earlier.

“I take care of people who have highly advanced prostate cancer, as well as some people who have healing prostate cancer,” she said, “so my perspective is really crooked about the fact that I really want to make that diagnosis if things are healing.”

This also applies to Dr. Matthew Cooperberg, a urological oncologist and professor at the University of California, San Francisco. He has forced to rename prostate cancer at an early stage, partly to facilitate the stress of a cancer diagnosis. A possible name, “Acinar Neoplasm“Describes abnormal growth, but someone who has no potential to spread or kill. Cooperberg also argues for monitoring men with raised PSAs before they hurry to biopsy their prostates.

“Men must get PSA tests in the midlife with the aim of finding aggressive prostate cancer,” he said. “If we find low illness along the way, regardless of whether we call it cancer, we should not treat it. We just follow it with active supervision. If we do that, we can delete this cancer.”

A new approach to the screening on prostate cancer is emerging

Dr. Tyler Seibert, a radiation oncologist and associate professor at the University of California, San Diego, is not so optimistic about eliminating prostate cancer. But he is also dedicated to finding ways to identify poor prostate cancer and to treat them alone.

When doctors first started with PSA screening tests, he said: “There was a lack of assumption that was implicit that if you find any form of prostate cancer, you should treat that kind of prostate cancer aggressively,” he said. “Many of them would never have damaged the patient.”

A new era in the screening of prostate cancer has arrived, Seibert believes. Nowadays, instead of men having their prostates biopsy immediately when they get an elevated PSA test, he and an increasing number of prostate cancer specialists recommend that you first get an MRI and, if possible, to look and wait.

“For these patients with prostate cancer with a low risk, we really have strong evidence that we can follow them closely, and they can actually just continue their lives,” he said.

Not everyone is familiar with getting periodic blood tests to see if their PSA might rise and they can indeed need the treatment of cancer, recognized Seibert. But most of his patients feel at ease with the protocol, he said.

“Every time you get that blood test, you are a bit nervous,” he said. “If you can tolerate that, and you don’t think it will cause you too much fear, then screening is very logical.”

Ronnie Cohen is a freelance health journalist based in the San Francisco Bay Area.