New prostate screening recommendations from the American College of Physicians (ACP) released today say 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.
Chief Medical Officer Otis W. Brawley, M.D. was very pleased with the new guidance.
“This new guidance for internists and other clinicians from the American College of Physicians is very consistent with recommendations from the American Cancer Society. In 1997, the Society was the first organization to recommend that patients be informed of the known risks and potential benefits of screening. We were also the first organization to recommend that physicians go through a process of shared decision-making concerning prostate cancer screening.
“The current ACS statement notes that ‘[m]en should have an opportunity to make an informed decision with their health care provider about whether to be screened for prostate cancer, after receiving information about the uncertainties, risks, and potential benefits associated with prostate cancer screening.’ Most professional organizations now recommend for such informed decision making. While the US Preventive Services Task Force recommends against prostate screening. the group does recommend that men who request screening be informed of its risks and possible benefits, and then receive screening only if they still want it.
“Virtually every cancer screening test has limitations. Often those limitations involve harms. Several screening studies have failed to show a benefit in terms of a decrease in mortality from screening using PSA, while two studies do show it may be associated with a small decrease in risk of death. All published prostate cancer screening studies have some flaws in them that make them in no way conclusive.
“One thing prostate cancer screening studies consistently show is that a significant number of men are diagnosed with tumors that never would have been a problem and that a significant number of men receive unnecessary treatment with the accompanying side effects. The most serious of these treatment related side effects is death from cardiovascular disease due to hormonal therapy or post-operative complications.
“The American Cancer Society applauds all efforts at explaining these limitations to patients and the physicians who care for them. We also applaud efforts to increase the use of active surveillance as a treatment of low grade localized disease.”
For more information, see “Can Prostate Cancer Be Found Early?” on cancer.org.