US Preventative Services Task Force Upgrades PSA Screening from D to C
A blood test that measures prostate specific antigen (PSA) has been available for early detection of prostate cancer for decades. In 2012, based on the results of several large clinical trials showing little benefit is reducing mortality, the US Preventative Services Task Force graded PSA testing a category D (not recommended), determining that the risks outweighed the benefits. Recently, the recommendation was upgraded to category C ( selectively offering or providing this service to individual patients based on professional judgment and patient preferences) for men aged 55 to 69, based on updated clinical trial results demonstrating small but consistent mortality benefits. Importantly, routine PSA screening is not recommended, rather that the risks and benefits of screening are discussed and men and their health care providers make an individual decision.
The benefit of PSA screening is that prostate cancer be detected early and treated, thereby preventing the morbidity and mortality of advanced stage cancer. Recent evidence suggests that PSA screening prevents 1.28 men from dying of prostate cancer for every 1000 men screened. Risks include over diagnosis, stress and false positives, resulting in unnecessary treatment. While the specificity of PSA testing is high, ~90%, an elevated PSA level may be caused an enlarged prostate (benign prostatic hyperplasia) or inflammed prostate (prostatitis). Some men without prostate cancer may therefore have positive screening results (ie, “false-positive” results). In addition, drugs that are used to treat BPH, like dutasteride and finasteride may falsely reduce PSA. Patients on these medications who are undergoing PSA testing need to be counseled about the effect of dutasteride and finasteride on PSA testing.
Additional information about Dutasteride and Finasteride can be found in the Top 300 Pharmacy Drug Cards. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to the Top 300 Pharmacy Drug Cards. If your institution does not provide access, ask your medical librarian about subscribing.
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