American College of Physicians releases new prostate cancer screening guidance statement

April 8, 2013

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, according to new recommendations issued today by the American College of Physicians (ACP).

"Screening for Prostate Cancer: A Guidance Statement from the American College of Physicians" appears in the April 9 issue of Annals of Internal Medicine, published by ACP.

"Before PSA testing, doctors and patients should discuss the potential benefits and harms of screening and the patient's individual risk of prostate cancer, general health, and preferences for testing and evaluation," said David L. Bronson, MD, FACP, president, ACP. "Only men between the ages of 50 and 69 who express a clear preference for screening should have the . For most of these men, the harms will outweigh the benefits."

The guidance statement includes talking points for physicians to help them explain the benefits and harms of prostate and treatment.

"A small number of prostate cancers are serious and can cause death," said Amir Qaseem, MD, PhD, MHA, FACP, Director, Clinical Policy, ACP. "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 ."

There are substantial harms associated with prostate cancer screening and treatment, including:

  • Problems interpreting test results. The PSA test result may be high because of an but not because of cancer. Or, it may be low even though cancer is present.
  • If a is needed, it is not free from risk. The biopsy involves multiple needles being inserted into the prostate under , and there is a small risk of infection or significant bleeding as well as 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 percent higher risk), and loss of control of urination (approximately 11 percent higher risk) compared to no surgery.
ACP recommends against PSA testing in average-risk men younger than 50, in men older than 69, or in men who have a life expectancy of less than 10 to 15 years because the harms of screening outweigh the benefits. For men younger than 50, the harms such as erectile dysfunction and urinary incontinence may carry even more weight relative to any potential benefit.

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

ACP developed the guidance statement by assessing current guidelines developed by other organizations. ACP believes that it is more valuable to provide clinicians with a rigorous review of available guidelines rather than develop a new guideline on the same topic, when multiple guidelines are available on a topic, or when existing guidelines conflict.

Explore further: Benefits of prostate-specific antigen testing remain unclear

Related Stories

Benefits of prostate-specific antigen testing remain unclear

July 20, 2012
(HealthDay) -- It remains unclear whether the benefits of prostate-specific antigen (PSA) testing outweigh the harms, but evidence suggests that men with a longer life expectancy may benefit from testing, according to a provisional ...

Alternative PSA screening strategies could reduce harm

February 5, 2013
(HealthDay)—Compared with standard screening, alternative prostate-specific antigen (PSA) screening strategies could maintain good prostate cancer detection rates while reducing overdiagnoses and unnecessary biopsies, according ...

ACP releases new colorectal cancer screening guidance statement

March 5, 2012
The American College of Physicians (ACP) today issued a new guidance statement for colorectal cancer screening. Colorectal cancer is the second leading cause of cancer-related deaths for men and women in the United States. ...

Final word: Task force recommends against PSA-based screening for prostate cancer

May 21, 2012
Following a period for public comment, the United States Preventive Services Task Force (USPSTF) released its final recommendation for prostate cancer screening. The Task Force now recommends against PSA-based screening for ...

Expert panel suggests PSA test may benefit some men

July 16, 2012
(HealthDay) -- Men with a life expectancy of more than 10 years should talk with their doctor about getting a prostate-specific antigen (PSA) test for prostate cancer, an expert panel recommends.

Recommended for you

Stem cell therapy attacks cancer by targeting unique tissue stiffness

July 26, 2017
A stem cell-based method created by University of California, Irvine scientists can selectively target and kill cancerous tissue while preventing some of the toxic side effects of chemotherapy by treating the disease in a ...

Understanding cell segregation mechanisms that help prevent cancer spread

July 26, 2017
Scientists have uncovered how cells are kept in the right place as the body develops, which may shed light on what causes invasive cancer cells to migrate.

Study uncovers potential 'silver bullet' for preventing and treating colon cancer

July 26, 2017
In preclinical experiments, researchers at VCU Massey Cancer Center have uncovered a new way in which colon cancer develops, as well as a potential "silver bullet" for preventing and treating it. The findings may extend to ...

Compound shows promise in treating melanoma

July 26, 2017
While past attempts to treat melanoma failed to meet expectations, an international team of researchers are hopeful that a compound they tested on both mice and on human cells in a petri dish takes a positive step toward ...

Study may explain failure of retinoic acid trials against breast cancer

July 25, 2017
Estrogen-positive breast cancers are often treated with anti-estrogen therapies. But about half of these cancers contain a subpopulation of cells marked by the protein cytokeratin 5 (CK5), which resists treatment—and breast ...

Breaking the genetic resistance of lung cancer and melanoma

July 25, 2017
Researchers from Monash University and the Memorial Sloan Kettering Cancer Center (MSKCC, New York) have discovered why some cancers – particularly lung cancer and melanoma – are able to quickly develop deadly resistance ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.