Members of the American Urological Association (AUA) recently got together and made a series of new recommendations concerning prostate cancer screening. They now discourage screening men who are at average-risk under the age 55.
The AUA says that men should be particularly cautious before making the decision to go through with the screening and weigh the benefits against the potential harms.
The Association also stresses the importance of consulting a doctor about whether being screened is the right decision.
Before these new recommendations, the AUA encouraged healthy men over the age of 40 to consider PSA screening.
The AUA now believes that even though PSA screening may help prevent some prostate cancer deaths, it can also be the cause of painful biopsies in “healthy” mean, plus some other unnecessary treatments. Researchers from John Hopkins University reported in The Journal of Urology (November 2011 issue) that prostate biopsies are associated with a 6.9% hospitalization rate within 30 days of the procedure because of complications.
Urologist H. Ballentine Carter, who chaired the panel that wrote the new guidelines, said: “There really was no high-level evidence supporting the use of screening with PSA.”
He added that while the general public may be enthusiastic about PSA screening “the idea that screening delivers benefits may have been overexaggerated.”
The panel concluded that people who do choose screening should do annual tests instead of every two years.
Carter added: “I look upon this guideline… as the beginning of a targeted-based screening.” Mentioning that “instead of a one-size-fits-all approach, we’re trying to emphasize that there is a group of men between age 55 and 69 that are much more likely to benefit.”
Men above the age of 70 who are only expected to live 10 or 15 more years are not advised to be screened.
The American Cancer Society estimates that close to 239,000 men are expected to be diagnosed with prostate cancer this year, with an estimated 30,000 dying from the disease.
Carter said: “The evidence for the benefits of prostate cancer screening was moderate, but the quality of evidence on the harms was high. I think men need this information, they deserve to have this information and when they get it, some men will take the same information and decide they want to get screened” and others won’t”
It’s very important that men are aware of the possible harm that PSA testing can lead to, as well as the possible benefit of it being able to detect cancer.
This is why it is imperative that patients discuss the best course of action with their doctor.
Many experts agree with the new guidelines, but express concern about the impact it will have on doctors and their patients.
According to a study by researchers at UCLA’s Jonsson Comprehensive Cancer Center, a test for prostate cancer called A+PSA assay that measures levels of PSA and six specific antibodies found in the blood of men with the disease was more sensitive and more specific than the conventional PSA test used.
Researchers reported in NEJM (New England Journal of Medicine (March 2012 issue) that while PSA testing reduces prostate cancer mortality, it does not appear to reduce all-cause mortality.
In October 2011, the USPSTF (US Preventive Services Task Force) recommended against PSA-based screening for prostate cancer. They emphasized that their recommendation applied to men with no symptoms that might point the presence of prostate cancer.
The USPSTF wrote “The evidence is convincing that PSA-based screening programs result in the detection of many cases of asymptomatic prostate cancer. The evidence is also convincing that the majority of men who have asymptomatic cancer detected by PSA screening have a tumor that meets histological criteria for prostate cancer, but the tumor either will not progress or is so indolent and slow-growing that it will not affect the man’s lifespan or cause adverse health effects, as he will die of another cause first.”
Written by Joseph Nordqvist