Josh Fenton, M.D.
SA CRAMENTO – A comprehensive assessment by UC Davis researchers of more than 60 studies forms the basis for new national recommendations on prostate cancer screening. The assessment and findings were published on May 8 in the Journal of the American Medical Association.
The new screening recommendations, developed by the US Preventive Services Task Force, recommend that men between the ages of 55 and 69 take the decision to undergo a periodical prostate. Specific screening based on antigen for prostate cancer should be individual and should include a discussion with the clinician about the potential benefits and damage of screening. The Task Force recommended against screening for men aged 70 and older.
The Task Force has found that while screening offers a "small potential benefit for reducing the chance of prostate cancer mortality in some men," many men "potential screening damage." These include false-positive results that require additional testing and require possible biopsy, overdone diagnosis and over-treatment; and treatment complications such as incontinence and erectile dysfunction.
The new recommendation updates an earlier recommendation published in 2012, when the Task Force concluded that although there were potential benefits of screening for prostate cancer, the benefits outweigh the expected enough damage to do routine screening on that time to recommend. According to the Task Force's new report, the change of recommendation is partly based on additional evidence that has increased the task force's assurance about the role of screening in reducing the risk of death from prostate cancer and the risk of metastatic prostate cancer.
The evidence was compiled and analyzed for the task force by a team in the UC Davis Center for Health Policy and Research and led by Joshua Fenton, a general practitioner who investigated the effectiveness of different cancer screening methods. and technologies.
Fenton said the team worked on his systematic reviews for two years to answer five questions:
* There is direct evidence that PSA-based screening for prostate cancer decreases in short or long-term morbidity and mortality for prostate cancer and all-cause mortality?
* What are the disadvantages of PSA-based screening for prostate cancer and diagnostic follow-up?
* Are there indications that different treatment methods for incipient or screen-detected prostate cancer reduce morbidity and mortality?
* What are the disadvantages of the different app for treating cockroaches for incipient or screen-detected prostate cancer?
* Is there evidence that the use of a pre-biopsy prostate cancer risk calculator, in combination with PSA-based screening, accurately identifies men with clinically significant prostate cancer (ie cancer that causes symptoms or advanced disease) leads) compared with only PSA screening?
The team investigated 63 studies on prostate cancer screening that were mainly performed in the United States and Europe. Fenton said the process was thoroughly screened by the working group with public and expert assessment prior to, during and after completion of the study.
"I am very proud of our team," Fenton said. "The US Preventive Services Task Force process is meticulous and methodical and I think we have achieved our goal of conveying complete and unbiased information based on current evidence."
One of the main findings of the evidence: [19659003] * PSA screening in men aged 55 to 69 can prevent approximately 1.3 deaths from prostate cancer for 13 years per 1000 screened men
* Screening also includes three cases of metastatic prostate cancer per 1000 screened men * False positive PSA results occur in 10-18 percent of the screened men, and up to half of the men in whom the cancer diagnosis was made because of screening, would never have been diagnosed with cancer if they had not been screened
* One in five men undergoing radical prostatectomy develops long-term urinary incontinence
* Approximately half of the men who undergo a radical prostatectomy will experience erectile dysfunction in the long term
* The damage of screening in men over 70 years of age is at least moderate and greater than in younger men due to an increased risk of false positives, damage from diagnostic biopsies and treatment damage
Fenton said that he often discusses screening with his male patients and that this study reinforces the need to find the time to do this.
"We need to explain the problems to patients and help them to make a decision that is in accordance with their values and preferences," he said. "This is not always easy to do during busy office visits, but it is necessary when the advantages and disadvantages are closely balanced."
Other authors of the review at UC Davis are Joy Melnikow, Megan S. Weyrich and Shauna Durbin from the Center for Healthcare Policy and Research and Yu Liu and Heejung Bang from the Department of Biostatistics at the Department of Public Health Sciences.
– UC Davis News
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