Guidelines for Prostate Cancer Screening

Men should discuss the benefits and risks of prostate cancer screening with their doctors, according to revised prostate cancer screening guidelines from the American Cancer Society (ACS). While this isn’t a radical change from the previous recommendations, the new guidelines offer clearer guidance on what should be discussed.

Difficulty determining who should be treated

Early prostate cancer is typically found using a PSA test and a DRE. Some prostate cancers grow slowly and may never cause a man any problems, while others are more aggressive and may spread to bones or other organs causing pain, discomfort, and even death.  Treatments for prostate cancer can have a lot of unpleasant side effects like incontinence and impotence that can really affect the quality of a man’s life.

Unfortunately, doctors can’t be sure which men need treatment and which would be fine without any therapy.

What the revised guidelines say

Because of these complex issues, the American Cancer Society recommends that doctors more heavily involve patients in the decision of whether to get screened for prostate cancer. To that end, ACS’s revised guidelines recommend that men use decision-making tools to help them make an informed choice about testing.

ACS recommends that men with no symptoms of prostate cancer who are in relatively good health and can expect to live at least 10 more years have the opportunity to make an informed decision with their doctor about screening after learning about the uncertainties, risks, and potential benefits associated with prostate cancer screening. These talks should start at age 50. Men with no symptoms who are not expected to live more than 10 years (because of age or poor health) should not be offered prostate cancer screening. For them, the risks likely outweigh the benefits, researchers have concluded.

As in earlier guidelines, ACS recommends men at high risk – African-American men and men who have a father, brother, or son diagnosed with prostate cancer before age 65 – begin those conversations earlier, at age 45. Men at higher risk – those with multiple family members affected by the disease before age 65 – should start even earlier, at age 40.

For men who are unable to make a decision about screening after these conversations, ACS recommends the doctor make the call based on his or her knowledge of the patient’s health preferences and values.

For men who choose to be screened after discussing the pros and cons with their doctor, the new guidelines make the digital rectal exam (DRE) optional and offer the option of extending the time between screening for men with low PSA levels.  For example, for men less than 60 years of age who have a PSA less than 1.0ng\ml, they probably can get tested every 18 months to 24 months instead of every year.

Bottom Line: Prostate cancer is a common condition affecting nearly 225,000 men each year and causes 26,000 deaths each year.  Men should have a discussion with doctor about the benefits of PSA testing and then make the decision with all of the information to make an informed decision.

For more information contact the American Cancer Society (http://www.cancer.org/docroot/NWS/content/

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