Doctors should educate their patients better about the risks and benefits of prostate cancer screening, according to new guidelines from the American Cancer Society.
Physicians should discuss the downsides to the blood test, known as prostate-specific antigen screening, or PSA, including potential diagnosis of cancers that may never harm them or kill them and along the way, exposing them to unnecessary treatment, the recommendations say.
The guidelines also question the use of digital rectal exams saying they should be considered optional, not a standard part of screening.
The guidelines come on the heels of several studies that raise doubts about PSA testing. The recommendations reference early findings of two long-range studies underway about screening.
In one, researchers randomly assigned 76,600 men to two groups. One received annual PSA tests for 6 years and digital rectal examinations every year for 4 years and the other was the control. Researchers found little difference in prostate cancer death rates between the two groups after 7 years and again after a decade.
We reported here about a study last year raising concerns that men are being overtreated for the disease and as a result, subjected to unnecessary biopsies and treatment. And another study published last year in the Journal of the American Medical Association found that men are not getting adequate counseling from their doctors on the risks of screening.
Of course, not everyone is on board with this reasoning. The American Urological Association agrees with better education but stands by its recommendations that men start PSA testing at age 40.
Meanwhile, the American Cancer Society says at 50, men should simply begin weighing the options of this test. (With the exceptions of people at higher risk: African Americans or someone with a relative with prostate cancer before age 65. They should start evaluating the test at age 45, ACS says)
Confused yet?
It's not easy. The screening debates have been huge medical news of late and the more I talk to patients, the more confusion I hear. The bottom line: these are guidelines not hard and fast rules. Experts of all stripes tend to agree that patients should educate themselves and talk to their doctor when making screening choices.