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Prostate Cancer PSA Test: New Guidelines Issued

Most younger men and those over 70 don't need prostate cancer screening; middle-aged men should talk with their doctor

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"There is general agreement that early detection, including prostate-specific antigen screening, has played a part in decreasing mortality from prostate cancer," Dr. H. Ballentine Carter, who chaired the panel that developed the guidelines, said in an AUA news release.

There is more and better data about PSA screening available today than there was in 2009, so it is "time to reflect on how we screen men for prostate cancer and take a more selective approach in order to maximize benefit and minimize harms," Carter said.

One expert said the revised guidelines made sense.

"I think these guidelines are quite appropriate given the [slow-growing] nature of many prostate cancers," said Dr. Erik Goluboff, an attending urologist in the department of urologic oncology at Beth Israel Medical Center in New York City.

He agreed that discussions between a patient and his doctor on the PSA test are "extremely important."

"It has become increasingly evident that many, if not most, men diagnosed with early prostate cancer will never need treatment and can be spared the potentially devastating side effects of treatment such as urinary incontinence and erectile dysfunction," Goluboff said.

Some men, including black patients and patients with a family history of prostate cancer, may still decide to undergo PSA testing, he added. "This is in contrast to the U.S. Preventive Services Task Force, where a blanket statement that PSA screening is bad, regardless of individual patient risk, was made," Goluboff said.

A better test that pinpoints aggressive, life-threatening prostate tumors might be developed in the future, to better guide patients. "Hopefully, with discovery of better tumor markers, aggressive prostate cancers can be distinguished from [slow-growing] ones and only patients who need to will receive treatment," Goluboff said.

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