New Guidelines for Prostate Cancer Screening
American Cancer Society Says Men Need to Weigh Benefits and Limits of PSA Tests
The PSA Screening Conversation continued...
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
- 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
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
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.
"When we look at the biopsies of men who had PSA levels of between 2.0 and
4.0 ng/mL, between 15% to 20% of the time we find cancer," Bueschen tells
Thomas Kirk, who is president and CEO of the prostate cancer patient support
group Us TOO International, tells WebMD that the confusion surrounding PSA
screening points to the need for more research to distinguish between very
aggressive and indolent tumors.
"For the most part, doctors cannot tell a patient if his cancer will be
slow-growing or aggressive," he says.