Physicians should discuss the benefits and risks of PSA testing with their asymptomatic male patients who have life expectancies of greater than 10 years, but the risks outweigh the benefits of men with shorter life expectancies, according to a new evidence-based provisional clinical opinion on prostate cancer screening issued by the American Society of Clinical Oncology.
Physicians should discuss the benefits and risks of PSA testing with their asymptomatic male patients who have life expectancies of greater than 10 years, but the risks outweigh the benefits for men with shorter life expectancies, according to a new evidence-based provisional clinical opinion on prostate cancer screening issued by the American Society of Clinical Oncology.
Separately, the American Osteopathic Association issued a more strongly worded policy that the decision of whether or not to proceed with PSA-based screening should be made by a patient with consultation from his physician.
Both statements are in response to the May 2012 recommendations issued by the U.S. Preventive Services Task Force, which recommends against PSA-based screening for prostate cancer.
The benefits of screening include identifying higher-risk prostate cancer earlier when treatment may be more effective, while the risks include over-diagnosis, unnecessary biopsy and treatment, and treatment side effects, according to the ASCO clinical opinion, which was published online in the Journal of Clinical Oncology (July 16, 2012).
“Our critical review of the evidence, including data on younger subpopulations of men, shows that PSA testing should not be discounted,” said Robert Nam, MD, co-chair of the ASCO panel that developed the opinion and a uro-oncologist at Sunnybrook Health Science Centre, University of Toronto. “We recognize that many want this debate settled and want the answer to be clear-cut. But it isn’t. Until it is, we think physicians and men with longer life expectancies should be aware of the full scope of evidence on PSA testing for prostate cancer screening so they can make informed and shared decisions about the right course of action.”
The panel also recommends that information written in lay language be available to clinicians and their patients to facilitate the discussion of the benefits and harms associated with PSA testing before the routine ordering of the test. ASCO recently developed a decision-making tool, available at www.ASCO.org/pco/psa, which explains available data and important considerations about PSA testing in lay language and in a format men can use to discuss testing with their physicians.
The AOA policy, approved last week by members of the AOA House of Delegates, recognizes the importance and integrity of the patient-physician relationship and recommends that prostate cancer screenings be individualized. For instance, a patient who is African-American and also has a family history of prostate cancer should discuss PSA-based screening with his physician, the AOA said in a statement.
“As an osteopathic physician, I know that there cannot be a ‘one-size-fits all’ approach to screening patients for serious diseases like prostate cancer,” said Kevin P. Hubbard, DO, of Heartland Hematology-Oncology Associates in Kansas City, MO. “This new [USPSTF] recommendation is very confusing to patients and makes them unsure of whether or not they should get the PSA screening, but they should feel comfortable discussing their options with their physician.”
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