The American Urological Association, which has staunchly defended the PSA screening test in recent years, now says there's no need for men under 55 to consider the test. And men ages 55 to 69 who are considering PSA should consult their doctors about the test's benefits and risks, according to a new policy announced Friday. (Photo: Steve Earley, The Virginian-Pilot, via AP)
In a major break from the past, a leading medical group is advising men to think carefully before getting getting screened for prostate cancer.
The American Urological Association, which has staunchly defended the PSA screening test in recent years, says healthy men under 55 don't need routine annual screening. And men ages 55 to 69 who are considering the PSA should consult their doctors about the test's benefits and risks, according to a new policy announced Friday. Until now, the group had advised healthy men ages 40 and up to ask their doctors about the PSA.
Authors of the new guidelines "learned very quickly that there really was no high-level evidence supporting the use of screening with PSA," says urologist H. Ballentine Carter, who chaired the panel that wrote the new guidelines.
Some men and their doctors may be reluctant to stop screening, says Carter, a professor at Johns Hopkins University School of Medicine in Baltimore.
"The public is very enthusiastic about screening, partly because of our messaging," Carter says. "The idea that screening delivers benefits may have been overexaggerated."
But Carter notes that "if a physician and patient sit down and the patient really, really understands the risks and benefits, then it's been absolutely proven that a substantial minority will not choose to be screened."
Given the limited benefits of the PSA, and the risks from cancer treatment, the urology group doesn't recommend PSA screening for men 70 and older who are expected to live less than 10 to 15 more years.
Men with prostate pain or other problems should still talk to their doctors about their symptoms, the group says. Younger men at high risk of prostate cancer should also ask their doctor's advice. Men at higher risk include African Americans and those with a very strong family history of prostate cancer, defined as cancer that develops before age 50, in multiple first-degree re latives, such as fathers or brothers, Carter says.
"It's a big change," Carter says. "An obvious questions is, 'Why is the (urology group) all of a sudden changing their stance?'"
Urologists have mostly continued to promote the PSA, even as other medical groups have backed away from recommending the blood tests. Last year, the urology group harshly criticized a federal expert panel that suggested men avoid the PSA entirely.
Carter notes that the group's 2009 "best practices" statement, which encouraged PSA testing, was based on a consensus of expert opinion.
The new guidelines were based strictly on medical evidence from rigorously designed clinical trials, Carter says. Urologists considered the same evidence used by the federal panel, the U.S. Preventive Services Task Force. Urologists also followed standard guidelines for making health recommendations, set out by the Institute of Medicine, he says.
"This was a much more sound scientific proce ss," says prostate surgeon Peter Scardino, chair of the surgery department at New York's Memorial Sloan-Kettering Cancer Center.
Research suggests that PSA screening may prevent one death from prostate cancer for every 1,000 men screened over a 10-year period, the urology group says. Yet many men who undergo PSA screening will be harmed, because of treatments that can lead to incontinence or impotence. Even undergoing a prostate biopsy, in which prostate tissue is removed with needles, puts men at risk for being hospitalized for an infection or other complication.
The urologists' stance on prostate cancer screening is now more in line with that of the American Cancer Society and five other medical groups, which emphasize "shared decision-making" â€" they advise men to talk to their doctors about the risks and benefits of PSA. Three medical groups, including the U.S. Preventive Services Task Force, advise men to skip screening.
The new recommendations are a "radical change," but a welcome one, says Michael Palese, associate professor of urology at the Icahn School of Medicine at Mount Sinai, who was not involved in writing them.
"It will help to change the current climate of over-biopsy and overreaction when it comes to PSA," Palese says. "On the other hand, we do need to continue to keep a vigilant watch on those patients who have prostate cancer that should be treated and will benefit from treatment."
Otis Brawley, the American Cancer Society's chief medical officer, says the urology group's official statement on screening has always been more nuanced than many people â€" including its members â€" realized. That's led many individual urologists to strongly promote the PSA to patients, while minimizing the risks.
"Some of the doctors just don't understand the technical issues in screening and don't understand what the risks are," Brawley says.
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