MedicalResearch.com Interview with:
Alex Krist, M.D., M.P.H
Professor of family medicine and population health
Virginia Commonwealth University and
Active clinician and teacher at the Fairfax Family Practice residency
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Prostate cancer is one of the most common cancers to affect men. However, the decision about whether to be screened is complex and personal. The U.S. Preventive Services Task Force reviewed the latest research on the benefits and harms of screening for prostate cancer using PSA-based testing, as well as evidence on treatment.
We found that men who are 55 to 69 years old should discuss the benefits and harms of screening with their doctor, so they can make the best choice for themselves based on their values and individual circumstances. Men age 70 and older should not be screened, as the benefits of screening diminish as men age and the harms are greater.
MedicalResearch.com: What should readers take away from your report?
Response: The science tells us that the decision to be screened between the ages of 55 and 69 should be an individual one, made only after a conversation between each man and his doctor about the potential benefits and harms. The main benefit of screening men in this age group is a small reduction in their risk of dying from the disease or having the cancer spread to other cells in the body.
However, there are also harms associated with screening. Most notably, the PSA test produces frequent false-positive results, which can lead to repeated follow-up tests and biopsies. Another important harm is overdiagnosis, which happens when screening leads to the diagnosis of prostate cancer in some men who would not have experienced symptoms from cancer during their lifetime, and therefore would not benefit from treatment. Additionally, treatment for prostate cancer can result in erectile dysfunction and urinary incontinence. Men who are willing to accept these harms in exchange for a possible benefit can choose to be screened, and men who would rather avoid the potential harms may choose not to be screened.
In men age 70 and older, the potential benefits do not outweigh the harms, and we recommend against screening men in this age group.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: There are several areas that need more research to improve screening and treatment for prostate cancer. The Task Force remains concerned about the striking lack of evidence on the potential benefits and harms of screening for prostate cancer in men at higher risk, particularly African American men and men with a family history of prostate cancer. We strongly advocate for research in this area—this should be a national priority. For example, we need more studies that explore when these men should begin screening, as well as research that shows how we can inform men at risk about the benefits and harms of screening.
Additionally, we need better screening tests to distinguish men who will have cancers that will spread from those who have cancers that won’t. Additional research is needed to identify screening methods, such as risk stratification tools and the use of baseline PSA level as a risk factor, that can point to cancers that will be aggressive and spread versus when cancers will grow so slowly that they never cause symptoms.
MedicalResearch.com: Is there anything else you would like to add?
Response: It’s important for men ages 55 to 69 who are considering screening to understand both the potential benefits and harms, and to discuss them with their clinician so they can make a choice that’s right for them. This includes men who are at increased risk for prostate cancer, such as African American men and men with a family history. Any man who is concerned about his risk for prostate cancer or who is wondering if he should be screened should talk to his doctor.
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