According to new guidelines released by the American Urological Association, average-risk men between the ages of 40 and 54 should not get prostate-specific antigen (PSA) testing for prostate cancer. And even those ages 55 to 69 who have no risk factors should talk with their doctors about the benefits versus potential harms of the test before choosing whether or not to get a PSA test. If these men do chose to get the test, they should not repeat it for at least another two years, absent specific indications.
These new guidelines are more in agreement with the current recommendations by the United States Preventive Services Task Force, which say that PSA testing should not be used to routinely screen for prostate cancer. Their logic is based on the idea that PSA tests do not help doctors differentiate between tumors that may be life-threatening versus those that may be so indolent (slow-growing) that they will never cause any harm to the individual. And the procedures that may be done in response to PSA test results have been shown to cause more harm than benefit.
In response to these guidelines, the panel's chairman, Dr. H. Ballentine Carter of Johns Hopkins Hospital, said, We're not saying ¦that there aren't some men who might benefit. And Dr. J. Stuart Wolf, chair of the AUA practice guidelines committee, points out the importance of patients talking to their doctors about whether or not to get the test.
ACSH's Dr. Gilbert Ross expressed some pleasant surprise at the urologists change of heart. The general response of those surgeons whose main livelihood is closely tied up with dealing with abnormal PSAs has been denial and resistance. Many men feel the same, reluctant to abandon the test they have been getting annually for years. Hopefully primary care doctors and prostate specialists will be encouraged now to spend time explaining the pros and cons of the test instead of just ordering it without much thought.
ACSH's Dr. Elizabeth Whelan wondered if most men were actually aware of their PSA results, or if they knew they got the test at all. I think that some doctors include the PSA test on their routine profile without giving it much thought, or even telling their patients that they are getting the assay. That type of thoughtless screening must be discouraged, as it adds to both unintended consequences and healthcare costs.