Most Men Don't Need PSA Tests, Doctors' Group Says
American College of Physicians notes limited benefit of prostate cancer screening
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"The word 'cancer' is very frightening. If you have cancer, you naturally want to get risk of it. But, treatments come with significant risks," Bronson noted. Potential risks from prostate cancer treatment include urinary incontinence, erectile dysfunction, anxiety and discomfort, according to the guidelines.
To prevent one death from prostate cancer, about 1,400 men would have to be screened, the guideline authors conclude. More than 100 men would have a false-positive PSA, and more than 100 men would be diagnosed with prostate cancer that might or might not need to be treated, and about half of those would experience a treatment-related complication, according to the NCI.
The ACP's first guideline recommends that physicians inform men between the ages of 50 and 69 years old about the risks and benefits of screening, taking into account each man's individual risk factors for prostate cancer and their life expectancy. In men who don't express a clear preference for screening, the ACP advises physicians not to use the PSA test.
The second guideline recommends against routine screening for men under 50 or over 69 years old, or men with a life expectancy of less than 10 to 15 years.
"What the ACP arrived at after looking at our guidelines and others is that men should be given information about the potential benefits and known harms from prostate cancer screening," said Dr. Durado Brooks, director of prostate and colon cancers for the American Cancer Society.
"If men want to be screened, it's certainly within their right. But they need to know we don't have studies that clearly demonstrate that screening can alter the course of prostate cancer. And we don't have evidence that screening provides better outcomes," Brooks said.
"I think there's a great deal of confusion surrounding prostate cancer screening, in part because the message has been that people should get screened, and the idea that screening isn't always a good thing is relatively new," he added.
Both Bronson and Brooks said that men shouldn't be screened at health fairs or other free screenings unless they've had a discussion with their doctor already about the potential risks and the limited benefits of the test.
If you're showing any signs of prostate cancer, such as blood in the urine or difficulty emptying the bladder, then you need to see your physician for a diagnostic evaluation, rather than a screening test. However, these symptoms don't always mean prostate cancer either and will likely warrant a discussion of risks and benefits of the PSA test in this situation, too, according to Bronson. Men who are having symptoms aren't addressed in the current guidelines.
The new guidelines appear online April 8 and in the May 21 print edition of the Annals of Internal Medicine.