The latest federal guidelines on prostate cancer screenings are important

Prostate cancer may be the most common non-skin cancer in the human race. Most men, if they live long enough, will develop the disease.

And yet, prostate cancer is also extremely unlikely to kill you. After five years, the survival rate is a whopping 98.6 percent. It’s a paradox of medicine that we are only beginning to understand.

{mosads}With prostate cancer treatment prone to significant impact to quality of life, a positive diagnosis for prostate-specific antigen, which is currently the disease’s clearest marker,  raises a difficult question for doctors: Is it wise to aggressively attack the tumor when treatment may be more dangerous than the disease?

With so much confusion about when to test and when to treat, the latest federal recommendations regarding prostate cancer screening from the U.S. Preventive Services Task Force (USPSTF) are incredibly important. They encourage thoughtful, informed conversations between primary care physicians and their patients in regards to the pros and cons of prostate cancer testing, and correct a dangerous trend of ignoring the disease completely.

Avoiding unnecessary risk

If prostate cancer could be treated without causing harm, every male would get tested regularly. Unfortunately, removal of tumors too often leads to impotence, incontinence and a range of other troubling outcomes, including the rare loss of life.

Because testing can also result in false positives, which can in turn lead to aggressive treatment, many men end up suffering from side effects without ever having been at risk for harm.

To help clarify such complex care situations, the U.S. Public Health Service established the USPSTF in 1984. Composed of experts in preventative medicine, the task force regularly evaluates the pros and cons of a wide range of tests and treatments, not just in cancer.

Based on the high risk of side effects that might damage quality of life, and the low risk of death from the cancer, as far back as 2008 the USPSTF recommended against screening for prostate cancer in men aged 75 or older, and in 2012 even recommended most men not get a PSA test. Sadly, in practice, those recommendations have been interpreted too bluntly.

Prostate cancer is deadly, for some

More than 28,000 Americans die from prostate cancer every year.

As an oncologic urologist, I treat prostate cancer patients daily. For those who have metastatic prostate cancer, where it spreads throughout the body, it is a terrible disease.

Recent studies have shown that since the earlier USPSTF recommendations, the number of patients diagnosed with high-risk prostate cancer — the ones with advanced disease from day one — have started to go up. Tragically, advanced disease is very difficult to cure.

While more data must be gathered, there appears to be an association between the national shift away from prostate cancer screening and a rise in patients diagnosed too late for us to heal them.

That’s why I’m encouraged that the USPSTF has released new draft recommendations, shifting from ruling out screening to advocating for individualized approaches, tailored to each patient, that arise from open conversations between patient and primary-care physician to address all pros and cons.

Those conversations will be important, and that shift towards recognizing the value of monitoring for some patients will encourage insurance companies to cover the test, as some had stopped doing so.

Better knowledge, better care

I regularly use robotic-assisted surgical tools and other techniques to limit side effects from prostate cancer treatment, and work with each patient and our team to develop a cancer plan that heavily weighs quality of life. However, for most prostate cancer patients, careful monitoring is still the best course of action,  not treatment.

For those of us in urology, our experiences and a growing data set have convinced us that testing is critical, but the test does not dictate how to proceed. Instead, it informs decisions that also weigh each patient’s individual history, genetics and wellbeing.

In the past, oncologists did not understand how to stratify prostate cancer patients according to risk, and we ended up treating too many patients who were never going to have a problem with the disease. Treatments continue to improve, as does the recognition of the critical importance of quality of life for cancer survivors.

All men should have a conversation with their primary care physician and urologist about prostate cancer, and the pros and cons of testing and treatment. With a shift away from urgent cancer removal to monitoring over time, medicine is arriving at a more balanced approach for prostate cancer. The latest USPSTF recommendations are a step in that direction, and a welcome change that, in time, will save lives.

Dr. Ahmad Shabsigh is a board-certified oncologic urologist at The Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. In addition to diseases of the prostate, he treats a wide range of urological cancers.

The views expressed by contributors are their own and not the views of The Hill.