Doctors’ Associations Release New Recommendations for Prostate Cancer ScreeningMay 7, 2013
Two physicians’ groups are now recommending informed decision-making when it comes to screening for prostate cancer. This is in line with American Cancer Society guidelines for early detection of prostate cancer.
The American Urological Association (AUA), the leading organization representing urologists, is recommending more moderate use of prostate cancer screening tests, according to a press release issued during its annual meeting in San Diego.
In its new guidelines, the AUA recommends that men ages 55 to 69 discuss the benefits and harms of prostate cancer screening with their doctors before deciding whether to be screened. It recommends against screening for men younger than 55 who are at average risk, as well as for men 70 and older.
The American College of Physicians (ACP) released a similar guidance statement in April. The ACP says men between the ages of 50 and 69 should discuss the limited benefits and substantial harms of the prostate-specific antigen (PSA) test with their doctor before undergoing screening for prostate cancer. The guideline says only men between the ages of 50 and 69 who express a clear preference for screening should have the PSA test.
These new recommendations are closer to those of the American Cancer Society and several other groups issued in recent years. The American Cancer Society recommends that men discuss the possible risks and benefits of prostate cancer screening with their doctor before deciding whether to be screened. The discussion about screening should take place starting at age 50 for men who are at average risk of prostate cancer and expect to live at least 10 more years. It should take place at age 45 for men who are at higher risk, including African-American men and men who have a father or brother diagnosed with prostate cancer, and at age 40 for men at even higher risk.
Previously, the AUA had recommended that PSA blood testing be offered to men starting at age 40. However, the results of 2 large clinical trials published since 2008 have called into question the benefits of routine PSA testing.
Otis W. Brawley, MD, MPH, Chief Medical Officer of the American Cancer Society, said, "I welcome any effort to explain to men the uncertainty, potential harms, and potential benefits of PSA screening. Use of this test should be a decision made by the individual patient in collaboration with his healthcare provider.”
Some limitations of screening
Screening looks for disease in people who have no symptoms. The main goal of prostate cancer screening is to reduce deaths due to prostate cancer. But the studies showed that the number of men who avoided dying of prostate cancer because of screening after 10 to 14 years was very small.
And screening isn’t perfect. Sometimes screening misses cancer, and sometimes it finds something suspicious that turns out to be harmless. The PSA test often produces false-positive results that lead to more testing, including biopsies, which can have their own side effects. Also, there aren’t reliable tests yet to tell the difference between prostate cancer that’s going to grow so slowly it will never cause a man any problems, and dangerous cancer that will grow quickly. Treatments for prostate cancer can have urinary, bowel, and sexual side effects that may seriously affect a man’s quality of life.