(NEW YORK) — Relaxed PSA screening guidelines may be leading to more late-stage cancer diagnoses, and the current recommendations updated to address this concern might preferentially serve white men, a new study suggests.

One in eight men will be diagnosed with prostate cancer in their lifetime, according to the American Cancer Society (ACS). One of the only available ways to screen for prostate cancer is by measuring levels of a protein called prostate specific antigen (PSA). But for years, doctors have debated the usefulness of this test, arguing that not all prostate cancer needs to be diagnosed, since it’s not always lethal, and doesn’t always need treatment.

“Many cases are extremely slow growing. Patients will die with prostate cancer, but not necessarily from prostate cancer,” said Dr. Moshe Ornstein, a genitourinary oncologist at Cleveland Clinic.

In 2012, a panel of experts known as the United States Preventative Task Force (USPSTF) recommended against PSA screening altogether, citing that universal testing may inflict harm due to overtreatment.

But since then, mounting evidence emerged linking less screening with more metastatic prostate cancer, meaning it has spread to distant organs and is no longer curable.

“Metastatic prostate cancer will require lifelong therapy,” Ornstein said.

According to the ACS, five-year survival drops from over 99% with local disease, to 31% once distant.

In 2018, after backlash, the USPSTF revised the guideline, recommending that patients talk to their doctors to determine if PSA screening is right for them, intending for this model to identify those most at risk.

Black men are twice as likely to die from prostate cancer compared to white men, so experts hoped that under the new guidelines, this demographic would be screened. But a new study out in JAMA found that Black men, despite their risk, may not be benefiting from the recommendations as they are currently written.

Researchers from the University of Kansas Medical Center included nearly three million men in their analysis. They trended rates of metastatic prostate cancer in relation to changing guidelines, and found that when PSA testing was discouraged entirely, metastatic disease rose in all groups. But after the guidelines were revised to recommend a conversation with a doctor, mounting rates plateaued in white men, but continued to climb in Black men.

Previous studies also found that after receiving the same education, White patients more often found PSA testing more beneficial, while Black patients more heavily considered the risk, their reasoning often informed by personal and historical experiences of racism and discrimination in healthcare.

“It doesn’t surprise me,” said Dr. Lee Kirksey, co-director of the Center for Multicultural Cardiovascular Care at Cleveland Clinic. “Black Americans have some degree of mistrust of the healthcare system. It is historical context that has been passed down through generations.”

Countless historical injustices have been implicated in this phenomenon, examples dating back as early as the 1840s, when enslaved African American women received experimental gynecological procedures without anesthesia.

Even as recently as the 1970s U.S. physicians were conducting trials withholding treatment from African American men with syphilis, watching as hundreds of men went blind, died and passed on the disease to their spouses and children.

“If you’re from a culturally Black family, you’ve heard of those stories,” Kirksey said. “And those stories are reinforced by the inequities we are seeing today.”

There may be ways to work toward better communication with minority patients, Kirksey said. Increasing patient-physician racial and ethnic concordance may help in establishing trust. Implicit bias training may teach physicians to identify the barriers to effective communication. Additionally, outreach programs may serve to meet patients where they are, using the voices of trusted healthcare workers from the community, in a location where patients are most comfortable.

“There are still concerns within the Black community,” Kirksey said. “It’s important that we continue to acknowledge those concerns, and implement solutions to address them.”

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(NEW YORK) — Six months ago, Dr. Joseph Boselli said he was prescribing the antiviral drug Paxlovid to nearly everyone who turned up at his practice with COVID.

Now, the internal medicine physician at Jefferson Health in Philadelphia said he’s reserving it mostly for people who are 60-plus, with serious health problems, or who aren’t up-to-date on their vaccines.

“I got four calls today, but I only gave Paxlovid to two because they were older,” said Boselli, an internal medicine physician at Jefferson Health in Philadelphia.

After Paxlovid hit the market in December 2021, the bitter, metallic-tasting antiviral pills were so successful at reducing the risk of hospitalization with COVID that many doctors were willing to prescribe the drug to younger adults too despite federal guidelines suggesting it should only go to high-risk patients.

The drug stops the virus from replicating in the body and works best when taken within five days of getting symptoms.

Now, after more than 164 million courses of Paxlovid have been shipped around the world since April, doctors say a clearer picture of the drug is emerging, including its limitations with younger population and the possibility of rebound.

“The tincture of time has showed us that while it is a great drug, and it really does work, it’s not meant for everybody,” said Boselli.

Here are three things to know:

Paxlovid helps older people survive COVID, but younger, healthy people see little benefit

Overall, the drug works as promised, doctors say, by dramatically reducing the chances that an older or high-risk individual might wind up hospitalized or dead.

What’s more is that it might help prevent “long COVID.”

A study released on Monday by the Veterans Administration looking at the medical records of 56,000 people found that taking Paxlovid early decreased the chances of experiencing “long COVID” by some 25%.

Still, the drug isn’t right for everyone, including people taking certain medications such as some cholesterol-lowering drugs and blood thinners.

Also, one study released this summer found little to no benefit for younger adults when looking at some 100,000 patients in Israel. While researchers found the drug reduced hospitalization by roughly 75% when given soon after infection to people 65-plus, it saw no measurable benefit for people ages 40 to 64.

In June, Pfizer announced it would stop enrolling “standard-risk” patients in a trial to see if the broader public might benefit.

In a statement at the time, Pfizer CEO Albert Bourla said, “With up to 40-50% of people around the world estimated to be high risk, we believe there remains a significant unmet need for treatment options to help combat this disease, and we will continue to prioritize efforts to advance the development of Paxlovid.”

‘Rebound’ cases are real and seriously underestimated

Less understood about Paxlovid and COVID in general is a person’s chance of “rebound” — a phenomenon in which a person recovers from an infection and tests negative, only to redevelop COVID symptoms or test positive within eight days after recovering.

The experience is frustrating because the recommendation is that the person return to isolation for another five days because people testing positive during rebound are thought to remain contagious.

The good news is that rebound cases are mild and mostly inconvenient, not life threatening.

The likelihood of getting rebound after taking Paxlovid was initially thought to be very small, less than 2 percent in most cases, according to the Food and Drug Administration and Pfizer, the company that makes the drug.

But doctors say those estimates now seem too low compared to the number of rebound cases being reported, including high-profile examples at the White House.

President Joe Biden and his wife Jill; Biden’s top medical adviser Dr. Anthony Fauci; and Dr. Rochelle Walensky, the head of the Centers for Disease Control and Prevention, each experienced rebound.

Doctors interviewed by ABC News put the real estimate of Paxlovid rebound at anywhere from 10 percent to as much as 30 percent of cases, even though no one knows for sure.

“I’m telling them (patients), it’s very common,” said Dr. George Diaz, of the Infectious Disease Society of America, of Paxlovid rebound.

But Diaz said he’s also telling patients that about a third of people who get COVID experience rebound even without treatment.

“There’s a good chance that you’ll have a rebound whether you take treatment or not,” he said. And with Paxlovid, studies have found “it significantly reduced chance of hospitalization and death,” Diaz added.

US officials more worried about COVID deaths than reports of mild rebound

Health experts and U.S. regulators says they are more concerned that vulnerable patients aren’t getting the drug than they are concerned about healthy people rebounding.

After Walensky wound up with her own case of Paxlovid, the CDC director noted there are still some 400 deaths a day due to COVID and made clear there were no plans to pull back on the government’s recommendation of the drug.

Bob Califf, her FDA counterpart, agreed. He announced on Monday that he tested positive for COVID over the weekend, and a spokesperson confirmed he is being treated with Paxlovid.

“I’m concerned that the discussions about ‘Paxlovid rebound’ are distracting us from the basis for the (drug’s authorization): a substantial reduction in death and hospitalization for high-risk patients,” he tweeted.

Dr. Judith O’Donnell, an infectious disease specialist at Penn Presbyterian Medical Center, said she agrees there are serious benefits for people 50-plus as well as younger patients with serious underlying health conditions like asthma, obesity or kidney disease.

“The drug does make a real and measurable difference in the trajectory of the infection,” she said.

So “even though there’s a risk of rebound, that would not prevent me from using it in the correct patient,” she later added.

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(NEW YORK) — The Centers for Disease Control and Prevention announced an investigation into a listeria outbreak that has been reported in six different states and has infected 16 people.

At least 13 people have been hospitalized and one pregnant person suffered a pregnancy loss due to the illness. Additionally, one death has been reported from Maryland, according to a release Wednesday.

Most people reported recently eating meat or cheese from deli counters, according to the CDC, who is now working to identify the specific products that may be contaminated.

The CDC also reported that 11 of the reported cases were found in people of Eastern European descent or who speak Russian.

Cases have been reported in California, Illinois, Maryland, Massachusetts, New Jersey and New York.

Listeria is a bacterial illness that happens after eating contaminated food. Each year, roughly 1,600 people get sick and 260 people die from listeria contamination. People who are pregnant, adults over 65 and immunocompromised people are most at risk, according to the CDC.

The CDC recommends cleaning the refrigerator, containers and surfaces that may have touched meat or cheese from a deli and to avoid consuming meat and cheese from a deli counter, especially for those considered high risk.

Symptoms of invasive illness caused by listeria — when the bacteria has spread beyond the gut — usually start within two weeks after eating contaminated food and can include fever, fatigue, muscle aches and confusion, among other symptoms. The CDC urged anyone who thinks they are experiencing symptoms of severe listeria illness after eating meat or cheese from a deli to call their healthcare provider right away.

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