Orders for prostate-specific antigen (PSA) tests didn't
significantly change at UT Southwestern Medical Center in Dallas
after 2012, when the U.S. Preventive Services Task Force (USPSTF)
recommended against it, warning with "moderate certainty" that the
benefits of PSA-based screening for prostate cancer do not outweigh
"It was important for us to have a good understanding of how we’re
using PSA testing and the impact of U.S. Preventive Services Task
Force," said senior author Dr. Yair Lotan, who is chief of urologic
oncology at UT Southwestern.
Prostate cancer is the most common malignancy in U.S. men, according
to the National Cancer Institute. An estimated 180,890 men in the
U.S. will be diagnosed with the cancer in 2016, and 26,120 will die
A PSA test measures the amount of a protein known as
prostate-specific antigen in a man's blood. Elevated levels
sometimes signal prostate cancer. Often, however, the test
incorrectly suggests there is cancer, according to the group. Those
so-called false positives can cause anxiety and lead to unneeded
Also, most prostate cancers tend to be slow-growing. Even if PSA
testing leads to a diagnosis of prostate cancer, it's not possible
to know if that cancer will ever cause a problem - but worried
patients may opt for unneeded treatments such as surgery, radiation
or hormone therapy.
Recently, actor Ben Stiller wrote online that a PSA test "literally"
saved his life by catching his early prostate cancer. The USPSTF
says there is no way to know which cancers will go on to be deadly,
To see if the USPSTF recommendation had an effect on test-ordering
patterns at their medical center, the researchers analyzed data from
275,784 hospital visits made between 2010 and 2015.
During that time, there were 63,722 orders for PSA tests. Primary
care providers ordered 17,315 of those tests and there were 858
referrals to urologists.
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Before and after the 2012 USPSTF recommendation, the researchers saw
similar numbers of PSA tests ordered per visit, similar numbers of
men being advised to see a urologist and similar average age at the
time of referral.
The researchers say adoption of external recommendations is slow and
There are also some conflicting recommendations from other panels
and organizations. Both the American Cancer Society and the American
Urological Association recommend more nuanced approaches to PSA
testing that involve discussions between patients and doctors.
Lotan said men should realize the risks of prostate cancer differ
depending on the person. For example, African Americans, men with a
family history and people with certain genetic predispositions are
at higher risk.
Proceeding with PSA testing is "a personal decision and the
important factor here is that men become informed about the
significance of it," he said.
He also cautioned that the new study can't speak for other medical
centers across the country.
"We can only report on the men at our institution and how the Task
Force's recommendation impacted our population," he said.
SOURCE: http://bit.ly/2dir8ID Cancer, online September 22, 2016.
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