In 2012 the United States Task Force released guidelines for PSA testing for prostate cancer that stated that no man should be tested for prostate cancer with a PSA test since there was far too many man who were over-diagnosed and who had treatment and complications from the treatment and that the cancer was so slow growing that few men would die of their prostate cancers.
Two physicians’ groups are now recommending informed decision-making when it comes to screening for prostate cancer. This is in line with American Cancer Society guidelines for early detection of prostate cancer.
The American Urological Association (AUA), the leading organization representing urologists, is recommending more moderate use of prostate cancer screening tests.
In its new guidelines, the AUA recommends that men ages 55 to 69 discuss the benefits and harms of prostate cancer screening with their doctors before deciding whether to be screened. It recommends against screening for men younger than 55 who are at average risk, as well as for men 70 and older.
The American College of Physicians (ACP) released a similar guidance statement in April 2013. The ACP says men between the ages of 50 and 69 should discuss the limited benefits and substantial harms of the prostate-specific antigen (PSA) test with their doctor before undergoing screening for prostate cancer. The guideline says only men between the ages of 50 and 69 who express a clear preference for screening should have the PSA test.
These new recommendations are closer to those of the American Cancer Society and several other groups issued in recent years. The American Cancer Society recommends that men discuss the possible risks and benefits of prostate cancer screening with their doctor before deciding whether to be screened. The discussion about screening should take place starting at age 50 for men who are at average risk of prostate cancer and expect to live at least 10 more years. It should take place at age 40-45 for men who are at higher risk, this includes African-American men and men who have a father or brother diagnosed with prostate cancer.
The discussion with the doctor should include an explanation to men of the uncertainty of the PSA test, potential harms from the prostate biopsy and treatments such as surgery and radiation, and potential benefits of PSA screening. Use of this test should be a decision made by the individual patient in collaboration with his healthcare provider.
Some limitations of screening
Screening looks for disease in people who have no symptoms. The main goal of prostate cancer screening is to reduce deaths due to prostate cancer. But the studies showed that the number of men who avoided dying of prostate cancer because of screening after 10 to 14 years was very small.
And screening isn’t perfect. Sometimes screening misses cancer, and sometimes it finds something suspicious that turns out to be harmless. The PSA test often produces false-positive results. For example men with an enlarged prostate gland or men with an infection of the prostate gland can have an elevated PSA level. Also, there aren’t reliable tests yet to tell the difference between prostate cancer that’s going to grow so slowly it will never cause a man any problems, and dangerous or aggressive prostate cancer that will grow quickly. Treatments for prostate cancer can have urinary, bowel, and sexual side effects that may seriously affect a man’s quality of life.
Bottom Line: The PSA is not a perfect test. It is inexpensive and it is non-invasive. It is useful as a baseline test and can help a man decide if he should proceed to a biopsy or to have treatment for his cancer. A thorough discussion between the man and his doctor is the best recommendation that I can provide for all men who are concerned about prostate cancer.