Revised Prostate Cancer Screening Guidelines: What Has—and Hasn't—Changed
Article date: March 3, 2010
By: Rebecca Viksnins Snowden
Men should discuss the benefits and risks of prostate cancer screening with their doctors, according to revised prostate cancer screening guidelines from the American Cancer Society (ACS). While this isn't a radical change from the previous recommendations, the new guidelines offer clearer guidance on what should be discussed.
Since 1980, ACS has released—and periodically revised—screening guidelines for the early detection of breast, cervical, colorectal, and prostate cancers. The last set of ACS prostate cancer guidelines was issued in 2001 and modified in 2008.
The revised recommendations are based in part on early findings from 2 large studies – one American, one European – which looked at whether prostate cancer screening with the prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) saves lives. The studies had different designs and tested different groups of men.
In the American study, known as the US Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, researchers randomly assigned more than 76,600 men to two groups: the men either received "usual care" or had annual PSA tests for 6 years and digital rectal examinations every year for 4 years. The researchers found little difference in prostate cancer death rates between the two groups at 7 years and again at 10 years of follow-up.
In the European trial, known as the European Randomized Study of Screening for Prostate Cancer (ERSPC), researchers randomly assigned 182,000 men from 7 different countries to either a control group or a screening group. Men in the screening group had PSA tests on average every 4 years and a DRE twice over that period of time. After about 9 years, the researchers found that screening reduced the rate of prostate cancer death by 20%. But they also found that 48 men would need to be treated to prevent one death from prostate cancer.
Final results from these studies will not be available for several years.
Difficulty determining who should be treated
Finding and treating prostate cancer early may seem like a no-brainer, but the issue is actually very complicated. Early prostate cancer is typically found using a PSA test and a DRE. There are limits to both methods, but the main issue is that even when these tests find a cancer, they often can't tell how dangerous the cancer is. Some prostate cancers grow slowly and may never cause a man any problems, while others are more aggressive. Treatments for prostate cancer can have a lot of unpleasant side effects like incontinence and impotence that can really affect the quality of a man's life.
Unfortunately, doctors can't be sure which men need treatment and which would be fine without any. And men who are told they have prostate cancer may have a hard time just doing nothing, even if the cancer is unlikely to cause them harm.
Clearly, some prostate cancers would cause problems at some point. For these men, screening and treatment is helpful. But often there's no way to know what the outcome would have been in any particular man's case without treatment.
What the revised guidelines say
Because of these complex issues, the American Cancer Society recommends that doctors more heavily involve patients in the decision of whether to get screened for prostate cancer. To that end, ACS's revised guidelines recommend that men use decision-making tools to help them make an informed choice about testing. The guidelines also identify the type of information that should be given to men to help them make this decision.
ACS recommends that men with no symptoms of prostate cancer who are in relatively good health and can expect to live at least 10 more years have the opportunity to make an informed decision with their doctor about screening after learning about the uncertainties, risks, and potential benefits associated with prostate cancer screening. These talks should start at age 50. Men with no symptoms who are not expected to live more than 10 years (because of age or poor health) should not be offered prostate cancer screening. For them, the risks likely outweigh the benefits, researchers have concluded.
As in earlier guidelines, ACS recommends men at high risk—African-American men and men who have a father, brother, or son diagnosed with prostate cancer before age 65—begin those conversations earlier, at age 45. Men at higher risk—those with multiple family members affected by the disease before age 65—should start even earlier, at age 40.
For men who are unable to make a decision about screening after these conversations, ACS recommends the doctor make the call based on his or her knowledge of the patient's health preferences and values.
For men who choose to be screened after discussing the pros and cons with their doctor, the new guidelines make the digital rectal exam (DRE) optional and offer the option of extending the time between screening for men with low PSA levels.
To learn more about the new guidelines, see Prostate Cancer: Early Detection or call 1-800-227-2345.
Reviewed by: Members of the ACS Medical Content Staff
ACS News Center stories are provided as a source of cancer-related news and are not intended to be used as press releases.
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