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ACP: Shared decision-making approach urged before PSA testing
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Clinicians should inform men aged 50 to 69 years of the limited benefits and significant harms of the prostate-specific antigen test before undergoing screening for prostate cancer, according to new recommendations issued recently by the American College of Physicians.
“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,” David L. Bronson, MD, FACP, president of the American College of Physicians (ACP) said in a press release. “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.”
David L. Bronson
To develop this guidance statement, the Clinical Guidelines Committee evaluated current guidelines in use by other organizations for prostate cancer screening in the United States. After searching the National Guideline Clearinghouse, the Committee selected four guidelines developed by the American College of Preventive Medicine, American Cancer Society, American Urological Association and U.S. Preventive Services Task Force.
The ACP recommended against using PSA testing in average-risk men aged younger than 50 years, in men aged older than 69 years or in men who have a life expectancy of less than 10 to 15 years.
Harms associated with prostate cancer and screening include: problems interpreting test results; if a biopsy is needed, there is a small risk of infection, significant bleeding or even hospitalization; if cancer is diagnosed, it is often treated with surgery or radiation, which also carries risks.
“A small number of prostate cancers are serious and cause death,” Amir Qaseem, MD, PhD, MHA, FACP, director of clinical policy at the ACP said in a 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.”
Disclosure: The researchers report no relevant financial disclosures.
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