Prostate cancer screening on ASCO Choosing Wisely list

Prostate cancer has made its way into another set of Choosing Wisely recommendations, this time from the American Society of Clinical Oncology.

As part of its list, ASCO recommends that PSA-based screening not be performed in asymptomatic men who are expected to live less than 10 years-a position similar to one contained in the AUA’s screening guideline released in May. ASCO’s list also includes a cautionary statement on targeted therapy, which is often used for the treatment of renal cell carcinoma.

Choosing Wisely, an initiative of the American Board of Internal Medicine Foundation, is designed to encourage clinicians and patients to scale back medical tests and procedures that may be unnecessary and even potentially harmful. In previously released Choosing Wisely lists, the AUA,American Society of Radiation Oncology, and American Academy of Family Physicians have also made recommendations regarding prostate cancer screening and/or treatment.

Regarding prostate cancer screening, ASCO said in a statement: “Men with medical conditions or other chronic diseases that may limit their life expectancy to less than 10 years are unlikely to benefit from PSA screening. Studies have shown that in this population, PSA screening does not reduce the risk of dying from prostate cancer or of any cause. Furthermore, such testing could lead to unnecessary harm, including complications from unnecessary biopsy or treatment for cancers that may be slow growing and not ultimately life threatening.”

ASCO also recommended against the use of targeted therapy “intended for use against a specific genetic abnormality unless a patient’s tumor cells have a specific biomarker that predicts a favorable response” to the therapy.

“Compared to chemotherapy, the cost of targeted therapy is generally higher, as these treatments are newer, more expensive to produce, and under patent protection. In addition, like all anti-cancer therapies, there are risks to using targeted agents when there is no evidence to support their use because of the potential for serious side effects or reduced efficacy compared with other treatment options,” ASCO said.

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