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Physicians Seeking Middle Ground in Prostate Screening Debate

Joe Cantlupe, for HealthLeaders Media, November 3, 2011

"Uncertainty in medicine is more common than we usually let on, and the way to address uncertainty is to allow patients the central position in decision-making," Barry says.

The public has until November 8 to comment on the proposals. The USPSTF, an independent panel composed of primary care providers, conducts scientific evidence reviews of a broad range of clinical preventive healthcare services and develops recommendations for primary care clinicians and health systems.

Indeed, prostate cancer is a significant killer of men, and the issues surrounding the screening, which is designed to catch the cancer early, pose a dilemma for physicians and patients.

Prostate cancer is the most commonly diagnosed nonskin cancer in men in the U.S. In 2010, an estimated 217,730 American men received a prostate cancer diagnosis, and an estimated 32,050 men died from the disease. The majority of deaths due to prostate cancer occur after age 75.

One of the problems with the PSA test is that it often produces false-positive results that are associated with negative psychological impacts, including a patient's persistent worry about prostate cancer, according to the task force. Men who have false-positive tests are more likely to seek or have additional tests, such as biopsies, that also trigger a host of other ailments, the task force states. "The evidence is also convincing that PSA-based screening leads to substantial overdiagnosis of prostate tumors," the report adds.

The task force's latest findings will replace a 2008 report that showed insufficient evidence to make a recommendation about PSA-based screening for men under 75. At that time, the task force recommended against screening for men 75 and older.

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