Prostate cancer screening recommendation should prompt ...

Men and their doctors have lots to talk about in the wake of last week's health bombshell: a federal task force's draft recommendation that most can skip routine blood tests used to screen for prostate cancer.

After reviewing the latest scientific evidence, the U.S. Preventive Services Task Force indicated it would downgrade recommendations for routine PSA, or prostate-specific antigen, tests. The task force cited evidence that the tests have failed to significantly cut prostate-cancer deaths, and that they lead to too much unnecessary surgery and anxiety.

Patient advocates and some doctors howled in protest. The American Urological Association reiterated its recommendation for routine PSA screening, though it's working on new clinical guidelines.

Many men simply wondered: What now?

In Dr. Tomasz Beer's view, the best answer is that men need to talk about cancer risk and prevention with their doctors regularly and in-depth, regarding all types of cancer. Beer is a prostate cancer specialist and deputy director of the Knight Cancer Institute at Oregon Health & Science University.

"We in the cancer institute have come to the conclusion that we should not discard PSA testing completely. We should do it in a way that engages each man in a thorough discussion about the benefits and risks. ... It's not as simple as, 'Go do it' or 'Don't do it.'"

UPCOMING CONFERENCE

WHEN: 8:30 a.m. to 4:30 p.m. Saturday, Oct. 22

WHO SHOULD ATTEND: prostate-cancer patients and their families, those at risk, advocates for progress against the disease or anyone who?s interested.

COST: $35, includes conference materials, lunch and parking

REGISTRATION: Online or call 503-494-4393A chief concern with the PSA test is that, because it can detect early-stage cancer, it leads to treating cancers that don't need to be treated. Prostate cancer often grows so slowly that it never harms patients.

"In some ways," Beer says, "it would be nice to have different terminology -- to reserve the word cancer for the aggressive disease and come up with something less ominous for the condition that is less likely to spread."

Patients' typical and natural reaction to any cancer diagnosis is to excise the disease. Sometimes their doctors react similarly.

"We have to overcome the natural reaction to the word cancer," Beer says, "and ask: 'What am I really dealing with?' "

He and his colleagues at OHSU advocate "active surveillance," or carefully watching early-stage prostate cancer. A patient with early stage prostate cancer, for instance, might get a PSA test every three to six months, so their doctor can track changes, no matter how small. They might also undergo repeated prostate exams and biopsies at intervals that make sense on a patient-by-patient basis.

Changes indicating that cancer is growing aggressively, Beer says, are met with aggressive treatment.

The future might hold more diagnostic options. Researchers at OHSU and elsewhere are studying whether such tools as magnetic resonance imaging, or MRI, might effectively diagnose prostate cancer one day.

Imaging is difficult with prostate cancer because it's a soft-tissue abnormality growing out of the prostate, a gland in men's reproductive systems that's also composed of soft tissue.

Next to skin cancer, prostate cancer is the most common cancer among U.S. men. The American Cancer Society estimates 240,890 new cases will be diagnosed this year, and that about 33,720 men will die of the disease. It's the No. 2 cancer killer (behind lung cancer) of men.

- Katy Muldoon

Source: http://www.oregonlive.com/health/index.ssf/2011/10/prostate_cancer_screening_reco.html

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