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New Guidance for Prostate Cancer Screening

ACP recommends shared decision-making, clear patient preference before PSA testing (Apr. 9)

Men between the ages of 50 and 69 years should discuss the limited benefits and substantial harms of the prostate-specific antigen (PSA) test with their doctor before undergoing screening for prostate cancer, according to new recommendations from the American College of Physicians (ACP).

The guidance statement — published in the April 9 issue of Annals of Internal Medicine — includes talking points for physicians to help them explain the benefits and harms of prostate cancer screening and treatment.

“A small number of prostate cancers are serious and can cause death,” said Amir Qaseem, MD, PhD. “However, the vast majority of prostate cancers are slow-growing and do not cause death. It is important to balance the small benefits from screening with harms, such as the possibility of incontinence, erectile dysfunction, and other side effects that result from certain forms of aggressive treatment.”

According to the ACP, the “substantial harms” associated with prostate cancer screening and treatment include:

  • PSA test results may be difficult to interpret. The results may be high because of an enlarged prostate but not because of cancer, or they may be low even though cancer is present.
  • If a prostate biopsy is needed, it is not free from risk. The biopsy involves multiple needles being inserted into the prostate under local anesthesia, and there is a small risk of infection or significant bleeding as well as a risk of hospitalization.
  • If cancer is diagnosed, it will often be treated with surgery or radiation, which carry risks, including a small risk of death with surgery, loss of sexual function (approximately 37% higher risk), and loss of control of urination (approximately 11% higher risk), compared with no surgery.

Because the harms of prostate cancer screening outweigh the benefits, the ACP recommends against PSA testing in average-risk men younger than 50 years of age, in men older than 69 years, or in men with a life expectancy of less than 10 to 15 years. For men younger than 50 years, the harms, such as erectile dysfunction and urinary incontinence, may carry even more weight relative to any potential benefit, the ACP says.

“Studies are ongoing, so we can expect to learn more about the benefits and harms of screening, and recommendations may change over time,” said David L. Bronson, MD, FACP, president of the ACP. “Men can also change their minds at any time by asking for screening that they have previously declined or by discontinuing screening that they have previously requested.”

The ACP developed the guidance statement by assessing current prostate cancer screening guidelines developed by other organizations.

Source: ACP; April 9, 2013.

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