Prostate Cancer Screening: Medical Groups Review, Modify Guidelines

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June 27, 2013

The American Urological Association (AUA) is the latest health professional group to revise its screening recommendations for prostate cancer and now says that the widely used prostate specific antigen (PSA) blood test should be done primarily in men 55 to 69 who decide to be screened for prostate cancer.

The AUA's previous guideline on the PSA test was released in 2009 and recommended that all men get an annual PSA test beginning at age 40. Other groups previously had similar recommendations, but that advice recently came under fire as research showed that routine screening does not reduce the number of deaths from prostate cancer. Studies have also shown that screening with PSA often leads to significant harms. One example is unnecessary and painful biopsies when the test is positive in conditions other than prostate cancer (false positive). There can also be complications from treating slow-growing cancers that would not likely have caused problems.

When prostate cancer is confirmed with a biopsy, it is often difficult to differentiate between slow-growing and fast-growing tumors, which means that many men have undergone surgery, chemotherapy and radiation—and suffered the serious side effects those can cause—for tumors that would never have been life-threatening. Surgery for prostate cancer can result in life-altering side effects such as erectile dysfunction and urination problems.

The AUA's new guidelines recommend that men 55 to 69 discuss the pros and cons of screening with their doctors and, if they opt for screening, the PSA test should be done every two years instead of every year and less frequently if their PSA is very low (less than 1.0 ng/mL).

According to the AUA, for men 55 to 69, PSA testing will be preventing one prostate cancer death over 10 years for every 1,000 men screened. The new guidelines also recommend that men at higher-than-average risk of developing prostate cancer, including someone with a family history of the disease and African Americans, discuss the risks and benefits of screening before age 55 with their doctor.

Other groups have also recently revised their PSA testing guidelines, and no group recommends the sweeping screening that had been the norm for many years:

  • The American College of Physicians (ACP): let men ages 50 to 69 make an informed decision with their doctors based on risks and benefits, their general health, life expectancy, and preferences.
  • The American College of Preventive Medicine: no general screening, but men at increased risk should discuss the pros and cons beginning at age 45, or at age 40 for men at even higher risk (those with two or more close family members who had prostate cancer before age 65).
  • The American College of Surgeons: begin counseling men at average risk at age 50 so that they have the opportunity to make an informed decision, earlier for men at increased risk.
  • U.S. Preventive Services Task Force: no screening for men who have no symptoms of prostate cancer because the harms of screening outweigh the benefits.

The ACP also reminds men considering PSA testing that research is continuing and recommendations can change over time. To read a summary for patients of the ACP's latest guidelines, see their web page.

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

(April 2013) American Urological Association. Early Detection of Prostate Cancer: AUA Guideline. Available online at http://www.auanet.org/education/guidelines/prostate-cancer-detection.cfm through http://www.auanet.org. Accessed May 29, 2013.

(April 28, 2009) Kerr, Martha. AUA 2009: PSA Screening Should Be Offered Beginning at Age 40. Medscape Medical News. Available online at http://www.medscape.org/viewarticle/702001 through http://www.medscape.org. Accessed May 29, 2013.

(April 9, 2013) American College of Physicians. American College of Physicians releases new prostate cancer screening guidance statement. Available online at http://www.acponline.org/pressroom/prostate_cancer_screening.htm through http://www.acponline.org. Accessed May 29, 2013.

Qaseem A, et. al. Screening for Prostate Cancer: A Guidance Statement From the Clinical Guidelines Committee of the American College of Physicians, including excerpt ACP Talking Points for Physicians with Patients (listed under paragraph headed "Shared Decision Making Approach"). Ann Intern Med. 2013;158(10):761-769. Available online at http://annals.org/article.aspx?articleid=1676183 through http://annals.org. Accessed May 29, 2013.

(May 2012) United States Preventive Services Task Force. Screening for Prostate Cancer. Available online at http://www.uspreventiveservicestaskforce.org/prostatecancerscreening.htm through http://www.uspreventiveservicestaskforce.org. Accessed May 29, 2013.