Group Urges Cautious Approach to Prostate Screening

(March 5) -- Men worried about their risk of developing prostate cancer should not automatically have prostate screening tests after they turn 50 and should instead make a personal decision based on their own risk factors, according to new guidelines from the American Cancer Society.

The society decided to revise its recommendations after several studies concluded that the two methods used to detect prostate cancer -- a prostate-specific antigen (PSA) blood test and a digital rectal screening -- can be inaccurate and might even cause more trouble than they prevent.

The organization now advises men to discuss the pros and cons of screening with their doctors, and make a choice based on personal risk factors. Men who have no symptoms and no family history are advised to weigh their options at age 50. Those with risk factors -- African-Americans, those with brothers or fathers who've had prostate cancer -- should start the doctor-patient conversations by age 45.

The ACS revisions seem slight: Before the new suggestions, the society advised that doctors "offer" prostate cancer tests to men over 50. Now, it suggests "discussion" instead.

PSA tests and digital rectal screenings can yield false-positive results but can also produce normal results in men who actually have prostate cancer. "Unclear test results can cause confusion and anxiety," the ACS recommendations note.

The ACS also wants organizations to stop hosting mass PSA screening events, because they're rarely accompanied by educational efforts to inform men of the test's shortcomings or the potential that their prostate tumors don't need immediate treatment.

But at least one group, Zero: The Project to End Prostate Cancer, said it will continue hosting mass screenings, which have tested more than 100,000 men.

"The whole concept that you would do anything to reduce the amount of information you have does not make sense to me," Skip Lockwood, the group's president, told the Los Angeles Times.

Treating prostate cancer is a complicated issue. Sometimes, a man can live for decades with prostate tumors that never cause problems. That's why the ACS is also suggesting that doctors curb their use of digital rectal exams, which are designed to detect prostate tumors.

The trickiest part of dealing with prostate cancer is that doctors rarely know whether existing tumors will or won't cause harm. Still, a man who is pre-emptively treated may have been better off not receiving medical intervention.

In fact, prostate cancer screenings can cause more harm than good. Biopsies and subsequent treatments can lead to urinary and sexual dysfunction. And for every life saved by a prostate cancer treatment, 47 men are treated without cause, according to an analysis published last year in the New England Journal of Medicine.

"This doesn't mean the PSA test has no benefit for patients," Dr. Peter Schlegel, chief urologist at New York Presbyterian Hospital/Weill Cornell Medical Center, told the radio program "The Takeaway."

According to the Prostate Conditions Education Council, which suggests baseline PSA tests for men over 35, a fundamental knowledge gap might be to blame for the ongoing prostate debate. A recent report commissioned by the council found that 61 percent of men knew "a little" and 20 percent of men knew "nothing" about prostate health.

"The main confusion today in prostate cancer centers around two key issues -- when to be screened and what to do with the screening results," the council's president, Wendy Poage, said in a statement. "We must address these questions and encourage men to take appropriate steps to safeguard their health."