Experts urge medical associations to reconsider prostate cancer screening guidelines

Estimates of the new model show the long-term benefits of prostate cancer screening, suggesting that “the balance of screening benefits and harms may be more favorable than generally accepted. Expert writes New England Medical Journal.

“[Prostate-specific antigen] Screening has become less popular in recent years due to problematic reasons. ” Jonathan E. Shog, MD, Assistant Professor of Urology at Cleveland Medical Center, University Hospital and Case Western Reserve University, and Adjunct Assistant Professor at Weil Cornell Medical College, told Healio Primary Care. “These include misunderstandings of randomized trial results, the use of short-term data to estimate the benefits of screening, and the failure to take into account many prostate cancers that are clinically present without screening. “

Current, Recommended by the US Preventive Services Task Force Doctors screen men with prostate cancer 55 to 69 years old for each patient and not men over 70 years. The American College of Family Medicine does not recommend routine screening of men over the age of 55. American Cancer Society We recommend starting screening at age 40 based on men’s life expectancy and risk — And only after he has been advised on the “uncertainties, risks and potential benefits” of screening.

Jonathan E. Shoreg

According to Shoag, Yaw A. Nyame, MD, MBA, MHSAA urological oncologist at the University of Washington Medical Center, Jim C. Hu, MD, MPHSaid two large randomized controlled trials for prostate-specific antigen (PSA) screening: “obvious or futile” based on prostate results, according to urologists at Weill Cornell Medicine, and members of other research teams. Misconceptions are widespread, lung, colorectal and ovarian (PLCO) cancer screening trials, and a European randomized study (ERSPC) trial on prostate cancer screening. However, the researchers noted that the PLCO trial was not designed to adequately compare the benefits of screening with the benefits of not screening, because 90% of participants in the control group underwent PSA testing.

Meanwhile, the ERSPC results show that 570 men aged 55 to 69 need to be screened to prevent one death from prostate cancer. The findings were based on a 16-year follow-up written by researchers “Man often starts screening in their fifties and has a median age at death of prostate cancer of 80 years, so there is enough time to find out the mortality benefits of screening. We may not be able to provide it.”

Researchers have developed a model to further evaluate the long-term effects of prostate-specific antigen (PSA) screening. This model is based on the long-term survival of prostate cancer patients and competitive mortality in the United States. It is estimated that an additional 11 prostate cancer cases will need to be diagnosed to prevent long-term death from one prostate cancer death. 25 years.

Yo A. Name

“We used a conservative assumption Benefits of screening, And how other changes in the treatment of prostate cancer affect mortality,” Nyame said in an interview. “We also didn’t incorporate more recent improvements in screening or treatment with new technologies. In this sense, the model estimates are very conservative, which has been a huge benefit to PSA screening for over 25 years. .”

Researchers told Healio Primary Care that their model hopes that the medical community will consider recently published evidence and new technologies in the diagnosis, management, and treatment of prostate cancer.

Jim C. Fu

“The ideal scenario is for the professional association to recognize the long-term downstream benefits of PSA screening in terms of reducing the risk of prostate cancer metastasis and death in men with a life expectancy of 10 years or more.” Said Hu. In addition, it is ideal that the guidelines of these societies recognize that not all men who have a PSA test are eligible for a biopsy. Some men May have prostate MRI If normal, biopsies with elevated PSA can be avoided.