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Shared-decision making, clear patient preference recommended
before PSA testing
Video News Story |
Read Abstract |
Read Patient Summary
PHILADELPHIA, April 9, 2013 -- Men between the ages of 50 and 69
should discuss the limited benefits and substantial harms of the
prostate-specific antigen (PSA) test with their doctor before
undergoing screening for prostate cancer, according to new
recommendations issued today by the American College of Physicians
"Screening for Prostate Cancer: A Guidance Statement from the
American College of Physicians" appears in the April 9 issue of
Annals of Internal Medicine, published by ACP.
"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," said David L. Bronson, MD, FACP,
president, ACP. "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 guidance statement includes talking points for physicians to
help them explain the benefits and harms of prostate cancer
screening and treatment.
"A small number of prostate cancers are serious and can cause
death," said Amir Qaseem, MD, PhD, MHA, FACP, Director, Clinical
Policy, ACP. "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."
There are substantial harms associated with prostate cancer
screening and treatment, including:
Problems interpreting test results. The PSA test result may be
high because of an enlarged prostate but not because of cancer. Or,
it may be low even though cancer is present.
If a prostate biopsy is needed, it is not free from risk. The
biopsy involves multiple needles being inserted into the prostate
under local anesthesia, and there is a small risk of infection or
significant bleeding as well as risk of hospitalization.
If cancer is diagnosed, it will often be treated with surgery or
radiation, which carry risks, including a small risk of death with
surgery, loss of sexual function (approximately 37 percent higher
risk), and loss of control of urination (approximately 11 percent
higher risk) compared to no surgery.
ACP recommends against PSA testing in average-risk men younger
than 50, in men older than 69, or in men who have a life expectancy
of less than 10 to 15 years because the harms of prostate cancer
screening outweigh the benefits. For men younger than 50, the harms
such as erectile dysfunction and urinary incontinence may carry
even more weight relative to any potential benefit.
"Studies are ongoing, so we can expect to learn more about the
benefits and harms of screening, and recommendations may change
over time," said Dr. Bronson. "Men can also change their minds at
any time by asking for screening that they have previously declined
or discontinuing screening that they have previously
ACP developed the guidance statement by assessing current
prostate cancer screening guidelines developed by other
organizations. ACP believes that it is more valuable to provide
clinicians with a rigorous review of available guidelines rather
than develop a new guideline on the same topic, when multiple
guidelines are available on a topic, or when existing guidelines
About the American College of Physicians
The American College of Physicians is the largest
medical specialty organization and the second-largest physician
group in the United States. ACP members include 133,000 internal
medicine physicians (internists), related subspecialists, and
medical students. Internal medicine physicians are specialists who
apply scientific knowledge and clinical expertise to the diagnosis,
treatment, and compassionate care of adults across the spectrum
from health to complex illness. Follow ACP on Twitter and Facebook.