Personalizing PSA screenings for Men

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There are new standards regarding PSA screenings for men as they age.

Men have been told for decades that if they live long enough they will all die from prostate cancer. After age 40 men were told that they should get a PSA test once a year and that they should also receive a digital exam by their physician. Today those requirements are no longer standard.

“The United States Preventive Services Task Force (USPSTF) on May 8,2018 released a report with new recommendations regarding both PSA tests and digital screenings. It said that for men ages 55-69, the decision to undergo periodic PSA based screening for prostate cancer should be individualized…. A “C” recommendation. “Individuals and physicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Physicians should not screen men who do not express a preference for screening.

For men age 70 and older the potential benefits of PSA based screening don’t outweigh the harms, so this group should not be screened for prostate cancer… a “D” recommendation.

Click to see the full report 

Adequate evidence from randomized clinical trials also showed no prostate cancer mortality benefit of PSA based screening for men age 70 and older.”

It is now believed that there can be direct harm from poor diagnostic procedures. These include complications from the biopsy as at least 1% of biopsies result in complications requiring hospitalization.

The report also concluded that we should not screen men over age 70 because they do not report a mortality benefit for men over 70, but they do show increased likelihood of harm from screening, diagnostic evaluation, treatment, over-diagnosis and over treatment.  These harms can be psychological, and they can also occur as a result of active surveillance. Therefore, go gently or do not go at all when thinking about PSA screening for men over the age of 70.

Listen to our Healthcast as we discuss PSA testing and especially as we discuss some of the complications that arise from the treatment protocols that are used if they decide to operate on your prostate. Many of these outcomes are horrible in terms of the quality of life for the man who has them. They may stop or eliminate the cancer, but the side effects of the surgery can be awful. Many men express the preference of not having these treatments.

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author.

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