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PSA screening

  • 1.  PSA screening

    Posted 05-19-2020 17:19
    What is everyone's thoughts on PSA screening for people living with HIV? The USPSTF gives it a grade C and recommends prostate cancer screening should be an individualized decision for men 55 to 69 years of age.The guidelines note that the three most important risk factors for prostate cancer are: older age, African American race, and family history- however I not see anything specialized about HIV.

    However there is some evidence that suggests people living with HIV have worse outcomes for prostate cancer: https://jamanetwork.com/journals/jamaoncology/article-abstract/2740690


    Does an HIV diagnosis increase your proclivity to ordering a PSA test? 

    Thanks everyone! 


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    Gina Tomkus, PA-C
    San Diego CA
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  • 2.  RE: PSA screening

    Posted 05-22-2020 02:11

    The limited support is due to the shorter life expectancy of older patients from other causes. A great urologist we use pointed out that outcomes are fine in many of these and a better strategy is to only use it in men with a life expectancy over 10 years regardless of age. A healthy 70 year old with minor, limited comorbidities would be a great candidate for treatment.

     

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  • 3.  RE: PSA screening

    Posted 05-22-2020 15:28
    This is something I teach our medical students about.  The grade C recommendation is because PSA is not a great screening test for prostate CA and the risks are about equal to the benefits for those without a high risk (the groups you mentioned). PSA has low sensitivity (21%) and it has high specificity (91%) so it's much better as a diagnostic test than screening.  It also has a low PPV (30%).  Also prostate cancer is usually slow-growing and often does not cause mortality.  So although PSA screening offers a small potential benefit of reducing the chance of death from prostate cancer in some, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy and treatment complications such as incontinence and erectile dysfunction.  In my primary care practice, we don't offer PSA to men who don't express a preference to be screened.  I would apply the same logic to patients living with HIV since there is not data about screening impacting prostate CA in people living with HIV.

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    Aliza Norwood
    Austin TX
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  • 4.  RE: PSA screening

    Posted 05-22-2020 20:57
    Edited by James Adams 05-22-2020 20:57
    I check PSA levels on my patients over 50 and over 40 with FH prostate cancer.  I also do DARE (digital anal rectal exam) as well.  I have diagnosed probably 5-10 cases of prostate cancer from just DRE alone.  You'd be amazed at how many people do not know how to examine prostates.  PSA level also can provide some clues into dx of prostatitis.  I had a PSA level on a patient that was 9 today, and last one a year ago was 1.  That's quite a high PSA velocity, so he needs further w/u for sure!  So I'm old school with PSA check and I don't abide by USPSTF guidelines.  A wise mentor once told me: James, guidelines are for people who don't know what they are doing.  You know what you are doing, but use the information wisely.  

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    James Adams
    Rancho Mirage CA
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