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Monthly Archives: May 2016

To PSA or not to PSA. That is the question

Gavin LeSueur - May 7, 2016

The US Preventive Services Task Force (USPSTF) is updating its controversial guidance about prostate cancer screening, and a research plan was published online last week. The plan will guide a systematic review of the available evidence on prostate cancer screening.

In 2012, the organization formally recommended against routine prostate-specific antigen (PSA)-based prostate cancer screening for healthy men, regardless of age.

However, the document left room for use of the test in the clinic. “Clinicians should understand the evidence but individualize decision-making to the specific patient or situation,” read the final document, which was published in Annals of Internal Medicine (2012;157:120-134).

Nonetheless, use of the PSA test has since dropped, especially among primary care providers.

In their research plan, the USPSTF will be looking at multiple “key questions.” The very first question addresses higher-risk men: “Does the effectiveness of PSA-based screening vary by subpopulation/risk factor (e.g., age, race/ethnicity, family history, and clinical risk assessment)?

What does this mean to you if you are a male over 40? It means stay tuned. At the moment, if you have a change in what is normal (difficulty starting urination, poor flow, terminal dribbling and having to get up during the night to urinate) then you need to talk to your Doctor. If you have a family history or concerns, talk to your Doctor. At this point in time your Doctor is unlikely to recommend PSA screening in a well, low risk male with no symptoms.

An aspirin a day keeps the doctor away?

Gavin LeSueur - May 3, 2016

Low dose aspirin is being recommended for primary prevention in people 50 to 70 years olf due to its benefits in preventing colorectal cancer and cardiovascular diseases. If you have a 10% or greater risk of developing cardiovascular disease over a ten year period then the US Preventative Services Task force recommends low dose aspirin should be initiated for adults between 50 and 59 years. If can also be offered to those aged between 60 – 69 but is slightly less favourable due to the balance of bleeding risks. In Australia the recommendations are under review awaiting the outcomes of a major clinical trial. At this stage the National heart foundation in Australia does not recommend aspirin as primary prevention. Stay tuned!

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