The men and women who often treat prostate cancer are now recommending that the blood test commonly used to screen for it should be given a lot less often.
The American Urological Association released new guidelines that, if they're heeded, would dramatically reduce the ranks of men who would be candidates for PSA testing.
The prostate-specific antigen test can catch cancer early, but it frequently gives false alarms or identifies cancers that don't require treatment.
So the urology specialists now say this about screening for prostate cancer:
- Men under 40 shouldn't get PSA tests.
- Men ages 40 to 50 shouldn't be tested, if they're at average risk for the disease. Those at higher risk — such as African-American men and those with a family history of prostate cancer — should talk it over with their doctors.
- For men 55 to 69, the test makes the most sense. The AUA panel recommends a shared decision by doctors and patient about the test. Once testing begins, the panel says it should be given every two years, rather than annually.
- Finally, the group says men over 70 and with less than a 10 to 15 year life expectancy can probably skip the test.
But the evidence reviewed by the panel supports the stance. PSA screening can prevent about 1 death from prostate cancer for every 1,000 men screened over a decade, the guideline says. But there are dangers from testing, including false positives and side effects from subsequent testing and treatment, including infections, impotence and incontinence.
"The public is very enthusiastic about screening, partly because of our messaging," Carter told USA Today. "The idea that screening delivers benefits may have been overexaggerated."
Almost a year ago the influential U.S. Preventive Services Task Force issued its own guideline saying healthy men should no longer get routine PSA tests.
The urologists disagreed then — and now. But the conversation has now shifted to how few men should get tested instead of how many.