MASSDEVICE ON CALL — The debate over prostate cancer screening took a rather conservative step forward this month with the American College of Physicians recommending that doctors only provide screenings to well-informed patients who’ve opted for a prostate-specific antigen, or PSA, test.
"Before PSA testing, doctors and patients should discuss the potential benefits and harms of screening and the patient’s individual risk of prostate cancer, general health, and preferences for testing and evaluation," ACP president Dr. David Bronson said in prepared remarks. "Only men between the ages of 50 and 69 who express a clear preference for screening should have the PSA test. For most of these men, the harms will outweigh the benefits."
The ACP press release highlighted some of the risks of screening, including difficulty in interpreting results, the chance that the test will lead to a biopsy and the risks associated with prostatectomy or radiation treatment should any cancers be detected.
"A small number of prostate cancers are serious and can cause death," ACP clinical policy director Dr. Amir Qaseem said in the press release. "However, the vast majority of prostate cancers are slow-growing and do not cause death. It is important to balance the small benefits from screening with harms such as the possibility of incontinence, erectile dysfunction, and other side effects that result from certain forms of aggressive treatment."
The study is the latest in what has been at times a vociferous debate over prostate cancer screening. Last summer a study appeared in the the New England Journal of Medicine that concluded that aggressive surgical treatment, the standard approach for prostate cancer treatment in the U.S., may be no better than “watchful waiting” as far as survival rates in patients with low-risk tumors.
In May 2012 a nationwide urologists lobbying group publicly chided the U.S. Preventative Services Task Force after the agency recommended that physicians set aside PSA testing over concerns that the risks outweigh the benefits. The panel was concerned about the dangers of aggressive prostate cancer treatment in patients who are asymptomatic and whose cancer may have remained neutral without intervention.
The Large Urology Group Practice Assn. expressed "outrage" at the USPSTF’s recommendation, warning that "failing to detect cancer early will create a public health catastrophe in 5-10 years."
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