Task Force Reverses Decision on PSA Guidelines

statin therapy

In a reverse move certain to cause some confusion, the U.S. Preventive Services Task Force has released revised PSA guidelines.

The task force, which recommended against routine PSA screening in 2012, now says men ages 55 to 69 should decide individually with their doctors whether and when to undergo the testing. It continues to recommend against prostate-specific antigen, or PSA, testing for men age 70 and older, saying potential risks outweigh any rewards of routine screening for this age group.

The 2012 recommendation was based on evidence that PSA screening resulted in overdiagnosis and unnecessary treatment that could leave men with urinary incontinence and sexual impotence. (Note about 70 percent of men with elevated PSA do not have prostate cancer when they are biopsied.) In addition, many PSA-detected cancers grow so slowly that some men are likely to die from something else instead.

“We were very concerned in 2012 that many, many men were being treated for prostate cancer,” said Kirsten Bibbins-Domingo, M.D., a professor of medicine at the University of California, San Francisco, and chair of the task force.

But new research, some of which suggests a small net benefit from screening, led the USPSTF to adjust its recommendation. “The new evidence allowed us to say that we think now the benefits do outweigh the harms,” Dr. Bibbins-Domingo said. “There is probably a small benefit overall to screening. The right decision is not a one-size-fits-all decision. The right decision isn’t screening all men, it’s making all men aware of the benefits and harms, and then allowing each man to make the best decision for himself. Now we can recommend that men have a conversation with their doctors about whether screening is right for them.”

PSA tests can detect prostate tumors at their most treatable stage, and several studies have reinforced not only the benefits of the tests, but also ways to lessen screening harms, including unnecessary biopsies and treatments.

One study in particular, the European Randomized Study of Screening for Prostate Cancer, found PSA testing cuts the chances of developing advanced prostate cancer by about 30 percent and the risk of dying from the disease by about 20 percent.

Some doctors are praising the USPSTF’s change of heart. “I view this as a victory for PSA screening for prostate cancer,” William Catalona, M.D., a professor of urology at the Northwestern University Feinberg School of Medicine told NPR. “PSA screening saves lives. And having the U.S. Preventive Services Task Force discourage PSA screening has sort of created a whole generation of family practitioners and internists who feel that PSA screening is a bad thing to do for patients. If this were to continue, we would lose all these gains in reducing the prostate cancer death rate.”

Otis Brawley, M.D. the American Cancer Society’s chief medical officer, agrees with the USPSTF’s revised guidelines, though for different reasons than Dr. Catalona.

“Prostate screening has been a contentious issue ever since the prostate specific antigen test became available some 30 years ago,” Dr. Brawley wrote today in a CNN commentary. “PSA has been shown to have a high false-positive rate and a high false-negative rate—literally missing as many prostate cancers as it finds.”

But, he told NPR, “I really do think that there is a pendulum in a lot of things that we do in medicine. And the pendulum here may be getting to the right place where we realize there are harms and there are benefits, and individuals need to weigh these harms and benefits and tailor a decision that’s right for them.”

The recommendation does not specify how often men might want to have their PSA levels screened. It is directed at men with average risk and those at increased risk of prostate cancer, such as black men, who are about two times as likely to succumb to prostate cancer as the general population, or men with a strong family history of the disease. But Dr. Bibbins-Domingo said further study is needed to figure out whether to screen these high-risk men more aggressively than those in the general population.

Prostate cancer is one of the most common types among men in the U.S., with nearly 13 percent being diagnosed with it over the course of their lifetimes, according to the National Cancer Institute. Roughly 180,000 American men are diagnosed with prostate cancer each year; at least 26,000 die annually from the disease.

 

This post originally appeared on BlackHealthMatters.com.

The Issue of Race Finally Explodes on ‘The Bachelorette’

Bachelorette Rachel Lindsay

In a clip that immediately started making news last week, The Bachelorette broke down in tears and said something black women all across the country could agree with: “you have no idea what it’s like being in this position.”

bachelorette Rachel Lindsay The Bachelorette Rachel Lindsay (Image: ABC)

 

If you’re not familiar with the world of first-impression roses, two-on-one dates, and fantasy suites, let me give you some background. Rachel Lindsay, a Dallas attorney, is the first black bachelorette in the 13-season history of the ABC series.

Before landing this historic gig, she was one of the final three women—and a fan favorite—on the previous season of The Bachelor with Nick Viall. The next season’s lead is usually picked from one of the previous runners-up, and the black contestants don’t usually get very far. After 21 seasons, we’re still waiting for the first black bachelor.

There are a number of think pieces about The Bachelor franchise, its lack of diversity, and its fraught relationship with race. And there are a lot of watchful eyes looking to see if Lindsay, and the most-diverse bunch of suitors ever, can change that.

You can count my two eyes among that bunch. I’ve been following both shows (and, yes, I’m ashamed to admit, Bachelor in Paradise—which had its own racially tinged scandal last week) for the last three years.

Like the rest of Bachelor Nation, I became a fast fan of Lindsay’s. I particularly appreciated how open she and Viall were, breaking the taboo in their conversations about race. I loved that on her hometown date she took him to a black church. And I wished all of America was watching when her family gently but firmly pushed back after Viall said he was colorblind with a reminder that though that may be true, the world is not, and that if he were to end up with their daughter he’d need to learn how to face that.

So for me it was a matter of when, not if, race would come up this season. And it didn’t take long. Just four weeks in, Lindsay was forced to acknowledge the pressure that comes with being the first black, or the only black, when there was a confrontation between two of her suitors and afterward the white man described the black man as “aggressive.”

I think her tears resonated with black women everywhere, who have often had to temper their emotions as they navigate the realities of constantly feeling judged as examples of their entire race and gender. How Lindsay ultimately deals is still to be seen—or, quite literally, to be continued—but it’s a conversation we’ll be having long after the final rose.

 

 

 

 

 

Gene Therapy May Kill Multiple Myeloma

Multiple Myeloma

Genetically using a person’s own immune cells to target cancer appears to virtually kill multiple myeloma, a blood cancer being diagnosed more frequently, according to an early trial from China.

The therapy, called CAR T-cell therapy, caused 33 of 35 patients with recurring multiple myeloma to enter full remission or have a significant reduction in their disease within two months.

In a second study, developed by the National Cancer Institute, nearly two dozen patients responded well to the treatment.

Experts at an American Society of Clinical Oncology conference in Chicago, where the results were announced last week, say though both studies were small, this is a first for multiple myeloma.

The results are “impressive,” said Len Lichtenfeld, M.D., deputy chief medical officer of the American Cancer Society. “These are patients who have had prior treatment and had their disease return, and 100 percent of the patients are reported to have had some form of meaningful response to these cells that were administered.”

For the new therapy, custom-designed for each patient, doctors collect the patient’s T-cells—one of the immune system’s main cell types—and genetically reprogram them to attack abnormal multiple myeloma cells.

The process is like a GPS, said lead researcher Wanhong Zhao, M.D., associate director of hematology at the Second Affiliated Hospital of Xi’an Jiaotong University in Xi’an, China. Immune cells are steered to cancer cells, making them assassins that never miss their target.

“The theory is [altered T-cells] should attack the tumor and continue to grow to become a long-term monitoring and treatment system,” Dr. Lichtenfeld said.

The technology represents the next step forward in immunotherapy for cancer, said Michael Sabel, M.D., chief of surgical oncology at the University of Michigan. “Immunotherapy is now really providing hope to a lot of patients with cancers that were not really responding to our standard chemotherapies.”

Historically, such therapies tend to be very expensive, Dr. Lichtenfeld said, and experts don’t see CAR-T breaking that cycle, should it receive approval. But it’s still early and much more research will be needed before that step.

The Chinese research team plans to continue the study with 100 patients at four hospitals in China. And a similar clinical trial will take place in the U.S. by 2018.

Multiple myeloma affects plasma cells, which make antibodies to fight infection. More than 30,000 cases occur each year in this country, with more than 115,000 worldwide. It’s the second-fastest growing cancer for men and the third for women, rising 2 percent to 3 percent per year, according to the NCI. Between 60,000 and 70,000 Americans have the blood cancer now, and only about 50 percent of them live five years after diagnosis.

 

This piece originally appeared on BlackHealthMatters.com.