ACP takes new stance on prostate cancer screening

The American College of Physicians has become the latest organization to weigh in on the controversial subject of PSA screening for prostate cancer.

The nation’s second-largest physician group recommends that men between the ages of 50 and 69 years discuss the "limited benefits and substantial harms of the PSA test" with their physician before undergoing screening. Only men between the ages of 50 and 69 years who express a clear preference for screening should have the PSA test, ACP said.

According to the authors of the recommendations, which were published online in Annals of Internal Medicine (April 9, 2013), "Men can change their minds at any time by asking for screening that they have previously declined or discontinuing screening that they have previously requested." ACP also recommended against screening for average-risk men younger than 50 or older than 69 years of age.

"For men younger than 50, the harms, such as erectile dysfunction and urinary incontinence, may carry more weight relative to any potential benefit. Men with a life expectancy of less than 10 to 15 years should not be tested because the harms of prostate cancer screening outweigh the benefits for this population," ACP said.

ACP has not taken a position on prostate cancer screening in more than 10 years. Recommendations from the United States Preventive Services Task Force, also published in Annals of Internal Medicine (2012; 157:120-34), took a stance against PSA-based screening altogether. ACP, by contrast, recommends that physicians inform patients of the substantial risks associated with screening before making a joint decision.

The new recommendations were developed by researchers from ACP’s Clinical Guidelines Committee, which reviewed available guidelines from other organizations. The recommendations include talking points for physicians to help them explain the benefits and harms of prostate cancer screening and treatment. The authors recommend that "physicians explain to patients that there are substantial harms associated with cancer screening and treatment, such as problems interpreting the test result; risks associated with biopsy (small risk of infection, significant bleeding, or hospitalization); and risks associated with surgery or radiation for cancer (small risk of death, loss of sexual function, and urinary incontinence)."

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