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Health Team

Expert opinion on prostate cancer screening shifts to more testing

Posted June 9

— Expert opinions on prostate cancer screening have recently shifted. Five years ago,  the U.S. Preventive Service Task Force recommended against using the PSA blood test.

But that stance has changed for many providers, and it involves an even closer doctor-patient relationship.

William Currie, 59, came to Duke Family Medicine for a check-up with Dr. John Ragsdale. Often it includes prostate cancer screening, but Currie believes his risk is low.

"Nobody in my family has had it,' Currie said. "They've had problems with other kinds of cancer, but not prostate cancer."

A blood test to detect a prostate cancer antigen (PSA) has been the subject of debate.

"You could have a positive screen," Ragsdale said. "Your levels could be elevated, but there can be other reasons why."

"And you can have really aggressive cancer and have a normal PSA , so it's not a perfect test," Armstrong said.

Duke medical oncologist Dr. Andrew Armstrong said the results can lead to over-diagnosis, over-treatment, high avoidable costs and life altering complications, including sexual disfunction and urinary bowel disfunction.

But new research shows a slightly greater benefit of PSA testing for early detection, which has led the United States Preventive Services Task Force to soften their stance against PSA screening.

Now they recommend "clinicians inform men ages 55 to 69 years about the potential benefits and harms of PSA based screening for prostate cancer." They say "the decision about whether to be screened for prostate cancer should be an individual one."

"It's not going to be a "one-size-fits-all" model," Ragsdale said. "I think what we're going to see moving forward - is more of an individualized screening plan for patients."

Early detection is still key. African American men are at 2 to 3 times more likely to develop and die from prostate cancer compared to Caucasian men, so it's even more important for them to discuss their risk with a physician.

"Early detection can prevent the complications of our treatments and of the disease itself if it were to spread," Armstrong said.

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  • Jeff Freuler Jun 10, 2:53 p.m.
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    At age 47 I was diagnosed with prostate cancer that was detected by a PSA test during a retirement physical. My PSA was just slightly elevated so I had a biopsy performed which the results showed cancer. The physical examination showed a normal prostate.

    So men get screened earlier than they recommend and just don't depend on one test.