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Prostate Cancer Screening Guidelines Recommend Not Using PSA Test

Experts point to increased risk of harm and uncertain benefits

New guidelines from Canada recommend that the prostate-specific antigen (PSA) test should not be used to screen for prostate cancer, based on evidence that shows an increased risk of harm and uncertain benefits. The guidelines were published in the Canadian Medical Association Journal.

“Some people believe men should be screened for prostate cancer with the PSA test, but the evidence indicates otherwise,” said Dr. Neil Bell, chair of the prostate cancer guideline working group. “These recommendations balance the possible benefits of PSA screening with the potential harms of false positives, over-diagnosis, and treatment of prostate cancer.”

For men with prostate cancer diagnosed through PSA screening, between 11% and 20% will receive a false-positive diagnosis and 40% to 56% will be affected by over-diagnosis, leading to invasive treatment, such as surgery, which can cause infection (in 11% to 21% of men), urinary incontinence (in up to 17.8%), erectile dysfunction (23.4%), and other postoperative complications, the guidelines say.

The prognosis for most prostate cancers is good, with a 10-year survival rate of 95%. Prostate cancer is generally slow to progress and is usually not life-threatening.

The guidelines, aimed at physicians, other health care professionals, and policymakers, contains prostate cancer screening recommendations for using the PSA test with or without manual rectal examination of men in the general population. Based on the latest evidence and international best practices, the guidelines update a previous version published by the task force in 1994.

Key recommendations include:

  • For men under age 55 and over age 70, the task force recommends not using the PSA test to screen for prostate cancer. This recommendation is based on the lack of clear evidence that screening with the PSA test reduces mortality and on evidence of increased risk of harm.
  • For men aged 55 to 69 years, the task force also recommends not screening, although it recognizes that some men may place high value on the small potential reduction in the risk of death, and suggests that physicians should discuss the benefits and harms with these patients.
  • The recommendations apply to men considered at high risk — black men and those with a family history of prostate cancer — because the evidence does not indicate that the benefits and harms of screening are different for this group.

The updated guidelines are consistent with the recommendations of the U.S. Preventive Services Task Force and the Cancer Council Australia. The United Kingdom does not have an organized screening program but recommends that men concerned about the risk of prostate cancer receive balanced information on the benefits and harms of screening.

Sources: MedicalXpress; October 27, 2014; and CMAJ; October 27, 2014.

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