New Guidelines for Prostate Cancer Screening: Do We Need No Screening or Smarter Screening?

In November as our grandfathers, dads, husbands, brothers, friends and boyfriends, raise cancer awareness by growing a longer beard or mustache, we also think about their health. The most prominent cancer among them is prostate cancer. According to the Centers for Disease Control and Prevention, it’s first among men of all races. Annually> 200,000 men are diagnosed with prostate cancer and an >30,000 will die of the disease. About 1 in 6 men in the United States will be diagnosed with prostate cancer in their lifetime, and about one in 35 will die of it.

Care for the guys is not debatable, but the PSA screening test has been somewhat ambiguous in years past and new guidelines were issued earlier this year.
The prostate gland produces PSA, a protein that at an elevated level may be a sign of prostate cancer. A high PSA reading also may indicate noncancerous conditions such as inflammation of the prostate (prostatitis) and enlargement of the prostate (benign prostatic hyperplasia).
Two years ago, the US Preventive Services Task Force surprised caregivers and the cancer prevention community when it gave the PSA test a rating of D, saying that the benefits did not outweigh the harms. Screening had led to overtreatment. The recommendations were significant; only ratings of B or higher ensure reimbursement from Medicare and Medicaid, and private insurers often follow suit.


The American Urological Society recommends the following:


• PSA screening in men under age 40 years is not recommended.
• Routine screening in men between ages 40 to 54 years at average risk is not recommended.
• For men ages 55 to 69 years, the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, shared decision-making is recommended for men age 55 to 69 years that are considering PSA screening, and proceeding based on patients’ values and preferences.
• To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce over diagnosis and false positives.
• Routine PSA screening is not recommended in men over age 70 or any man with less than a 10-15 year life expectancy.
(Source for AUA Guidelines: http://www.auanet.org/advnews/press_releases/article.cfm?articleNo=290)


Research estimates that 17% of men with abnormal tests will undergo an unnecessary prostate biopsy (ouch!) and 1 in five men will experience an abnormal PSA test. It isn’t that all men should never undergo PSA testing it is that we must be smarter about who to test when to test and why to test.

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