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New Guidelines for Prostate Cancer Screening

American Cancer Society Says Men Need to Weigh Benefits and Limits of PSA Tests

Benefits and Limits of PSA Tests continued...

In the screening era, about 18% of men are now diagnosed with prostate cancer and 2% to 2.5% die as a result.

"The death rate has definitely come down, but treatments are now better and other changes have occurred so it is unlikely that this is completely related to screening," Etzioni says.

The risk of being diagnosed with a clinically irrelevant prostate cancer is much greater for older men than for younger ones, she adds.

Impotence, incontinence, and bowel issues are common side effects of prostate cancer treatment.

The PSA Screening Conversation

Brooks says the conversation between a man and his health care provider should focus on his individual risk.

The new guidelines state that:

  • The discussion should begin at age 50 for men with an average prostate cancer risk and at age 45 for men at higher risk -- including African-Americans and men with a close relative diagnosed with the disease before age 65. For men at the highest risk, including those with a strong family history of the disease, the discussion should begin at age 40.
  • Men who are tested and have an initial PSA of less than 2.5 ng/mL can be retested every two years.
  • Yearly screening is warranted for men with PSA levels of 2.5 ng/mL or higher.
  • Men without prostate cancer symptoms who are not expected to live for at least 10 years are not likely to benefit from screening and should not be tested.
  • A PSA of 4.0 ng/mL or higher remains a "reasonable threshold" for recommending a biopsy.

Growing questions about the value of PSA testing led the nation's largest group of urologists to revise its own prostate cancer screening guidelines last year.

The American Urological Association dropped its recommendation for annual screening for men age 50 and older in favor of a first-time test at age 40, with the schedule of follow-up testing to be determined on an individual basis.

In a news release issued Wednesday, American Urological Association President Anton J. Bueschen, MD, applauded the American Cancer Society for stressing the importance of patient education in making decisions about screening. But he also warned that assigning a cutoff of 4.0 ng/mL for further evaluation will confuse patients.

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