Entries in PSA (4)


New PSA Testing Recommendations Ignites Debate Again

iStockphoto/Thinkstock(NEW YORK) -- Although the United States Preventive Services Task Force (USPSTF) recently recommended against routine screening for prostate cancer for most men, a panel of experts from the American Society for Clinical Oncology (ASCO) says that many men could benefit from regular testing.

The panel of ASCO experts recommended that men with more than 10 years to live discuss with their doctors the risks and benefits of screening and whether they should get their levels of prostate-specific antigen (PSA) tested. A high level of PSA may indicate the presence of cancer. The USPSTF, on the other hand, said back in May that routine PSA screening could lead to false positives, which in turn could mean overdiagnosis and overtreatment.

Treatment for prostate cancer, the task force noted, may cause a number of problems including erectile dysfunction and urinary incontinence.

ASCO, however, agreed with USPSTF that screening is not recommended for men with 10 years or less to live. Additionally, ASCO did not include a specific age recommendation, only life expectancy. Doctors are not required to abide by ASCO or USPSTF guidelines -- they are only recommendations.

"A lot of men that have a long life expectancy would benefit from screening, especially those that will be diagnosed with aggressive forms of prostate cancer," said Dr. Robert Nam, an ASCO panel co-chair and head of genitourinary cancer care at the Sunnybrook Research Institute in Toronto. "Men with aggressive prostate cancer can benefit from early treatment."

Nam added that the ASCO recommendations include talking with health care providers about other factors to take under consideration, including family history.

He also said that the panel agreed with USPSTF's concern about over-treatment, but is urging men who find out they have high PSA levels to learn how significant the results really are before getting treatment.

"The meaning of a result may be entirely different for different people," he said. "For example, the risk is much greater for an African American male with a family history of prostate cancer than it is for a Caucasian male with no family history, even if they have the same PSA score."

The American Cancer Society and the American Urological Association also agree that men should discuss their options with their doctors before undergoing screening.

In response to the USPSTF guidelines, the American Urological Association said men "who are in good health and have a 10-15 year life expectancy should have the choice to be tested and not be discouraged from doing so." The association also said the USPSTF's "blanket statement" should not be applied to at-risk populations, such as African Americans.

ABC News reached out to the USPSTF for a response to the ASCO recommendations, but the task force, a government-funded panel of independent primary care providers tasked with making preventive health recommendations, has not yet responded.

Nam said despite the recommendations, there is no clear answer on how beneficial PSA testing is. The panel based its decisions on a systematic review of studies done by the Agency for Healthcare Research and Quality (AHRQ). The USPSTF also used AHRQ data, but according to Nam, the data were a bit older and a couple of the studies were not very reliable.

Several doctors told ABC News they approach screening with their patients in a way that is more consistent with ASCO's recommendations.

"It's a much more reasonable and balanced approach than the USPSTF," said Dr. Peter Scardino, chief of surgery at Memorial Sloan-Kettering Cancer Center in New York. "The idea that we stop recommending PSA screening altogether is not tenable."

Scardino said some strong studies have found PSA testing led to a reduction in cancer-specific and overall mortality. Other studies, however, have found PSA testing to have no effect on the number of deaths.

Dr. Gerald Andriole, chief of urologic surgery at Washington University School of Medicine in St. Louis, said after discussing the risks and benefits of screening with his patients, many of them still opt for testing.

"They are worried about having prostate cancer and generally would prefer to have the test, knowing it is imperfect, than not getting tested at all. At least it gives them some information on which to make health decisions," he said.

An approach known as active surveillance involves monitoring low-risk cancers, but not treating them.

"Data to date suggest that with this approach we can identify the more aggressive, large cancers and still successfully treat them," said Andriole. "Active surveillance is apt to be better than early treatment with surgery or radiation therapy for many men with low-risk cancers and should lessen overtreatment."

Experts also agree that the development of better testing could someday provide a more definitive answer to questions about whether to perform routine screening.

Copyright 2012 ABC News Radio


‘Don’t Say Gay!’ Eighth Grader's PSA Goes Viral

Mario Tama/Getty Images(NEW YORK) -- A half-minute PSA called Don’t Say Gay has gone viral after YouTube user playahata646 and his little brother demonstrated a funny and pithy way to discourage people from using the phrase.

“In 8th grade we had a PSA project. (Public Service Announcement) "Don’t Say Gay." I chose a funny way to present it. Subscribe! And thanks to my little brother for being the star!” He wrote on his YouTube page.

The eighth grader’s little brother shines in the clip after he slaps his brother across the face and admonishes his brother for using the phrase, “gay.”

“Don’t say ‘gay,’” he yells. “It’s mean, and it’s offensive!”

Copyright 2011 ABC News Radio


PSA Tests for Prostate Cancer: More Harm than Good?

Comstock/Thinkstock(WASHINGTON) -- The U.S. Preventive Services Task Force publicized Friday its recommendation that healthy men should no longer receive PSA blood tests for prostate cancer as part of routine cancer screening. The government panel’s recommendation supports the growing notion that the blood tests often do more harm than good.

The blood test is designed to detect higher than normal levels of prostate-specific antigen, or PSA, in the blood. A high level can signal prostate cancer, but it can also indicate more benign conditions. A positive PSA test can lead to invasive biopsies, which come along with their own raft of considerations, including impotence and incontinence.

Science appears to support the recommendation. The USPSTF outlined in a report published early in the Annals of Internal Medicine that an analysis of the five largest studies on PSA testing suggested that the benefits of such tests appear minimal, while the downsides are considerable.

Still, some doctors worry that the recommendation could add to public confusion over the true benefits of screening tests that, in the past, they may have been encouraged to seek out. And it’s an issue that is not limited to prostate cancer screening; the USPSTF in 2009 recommended against annual mammograms for women age 40 to 49 because, they said, the benefits of testing do not outweigh the harms.

“The public often feels frustrated with the seeming ‘mixed messages’ that come from the medical establishment,” Dr. Jehan El-Bayoumi, residency director at George Washington University, told ABC News. “One minute we’re telling people to get screened, the next minute we’re telling people that it doesn’t make a difference. And so, no wonder the public is confused.”

Indeed, there is currently no overarching consensus on PSA testing. Dr. Pat Walsh of Johns Hopkins University, a world-renowned urologist and pioneer in nerve-sparing prostate surgery, called the updated recommendation “a shame.”

“This decision ignores the fact that there has been a 40 percent reduction in prostate cancer deaths over the past 10 years since PSA testing has been in place,” Walsh said. “The USPSTF ignores this because it relies only on randomized trials, and there are a number that have too short a follow-up and other serious deficiencies.”

Dr. Leonard Gomella, chairman of urology at Thomas Jefferson University, called the decision an “appalling affront to all men who will die from prostate cancer.” Dr. William Catalona, director of the Clinical Prostate Cancer Program at Northwestern Memorial Hospital, said, “The extent to which PSA screening causes over diagnosis and overtreatment is exaggerated.”

“I have to wonder whether economics are playing a role in the decision of the Task Force,” said Dr. Jerome Richie, chief of urology at Brigham and Women’s Hospital.

Several nonurologists, however, applauded the USPSTF’s move.

“I think this recommendation is long overdue,” said Dr. Thomas Schwenk, professor of family medicine at the University of Michigan.

“This advisory mirrors my advice to patients over the last 10 years,” said Dr. William Golden, director of general internal medicine at the University of Arkansas. “I have long believed that prostate cancer had a cure worse than the disease.”

“People have a need to believe, a need to feel that we have some power over this terrible disease,” said Dr. Lee Green of the University of Michigan. “Admitting the truth, that PSA screening doesn’t really save lives, is unacceptable because it takes that away. It’s scientifically correct, and will provoke a firestorm.”

Only time will tell whether the new USPSTF recommendation will be accepted by the medical community at large.

Copyright 2011 ABC News Radio


Graphic HIV/AIDS Video Horrifies Gay Community

Photo Courtesy - New York City Health Department (NEW YORK) -- A public service announcement produced by the New York City Health Department promoting condom use to prevent HIV/AIDS has horrified advocacy groups, who say it demonizes and frightens gays and those living with the disease.

The video, which aired on such cable networks as the gay and lesbian channel Logo, Bravo and the Travel Channel, chides, "When you get HIV, it's never just HIV. You're at a higher risk for dozens of diseases even if you take medications, like osteoporosis, dementia, and anal cancer."

Gay advocacy groups and blogs were barraged by complaints after viewing the video on YouTube.

The Gay and Lesbian Alliance Against Defamation and the Gay Men's Health Crisis in New York are demanding the video be withdrawn, saying scare tactics do not work and that the PSA is stigmatizing.

"While it's extremely important that we continue to educate New Yorkers about HIV/AIDS prevention, the sensationalized nature of the commercial, including its tabloid-like fear tactics, misses the mark in fairly and accurately representing what it's like to live with HIV/AIDS," said GLAAD President Jarrett Barrios.

"It's our hope that the department will work with us to create a PSA that promotes safety and solutions, rather than stigma and stereotype."

Copyright 2010 ABC News Radio

ABC News Radio