PSA test harms outweigh prostate cancer benefits in majority
medwireNews: Men should be warned that the chances of harm from screening with the prostate-specific antigen (PSA) test outweigh the likelihood of benefit for most men, says the American College of Physicians (ACP) in a guideline statement on prostate cancer screening.
Amir Naseem, from the ACP, and colleagues write in the Annals of Internal Medicine: "It is important for clinicians to convey to patients who may want to be screened that evidence indicates, at best, small benefits as well as substantial harms. Men who do not have a clear preference for screening should not be screened, and this should be documented."
They add: "Clinicians should help men judge the balance of benefits and harms and discuss whether the harms outweigh the potential reduction in prostate cancer mortality in their particular cases."
ACP assessed the current guidelines published by the American College of Preventive Medicine, the American Cancer Society, the American Urological Association, and the US Preventive Services Task Force. Using the AGREE II instrument of 23 questions in six domains, each of the guidelines was evaluated.
In two statements, the ACP first recommends that clinicians inform men aged 50-69 years about the limited potential benefits and substantial harms of prostate cancer. They say that clinicians should base the decision to screen for prostate cancer using the PSA test on the risk for prostate cancer, alongside a discussion of the benefits and harms of screening, the patient's general health and life expectancy, and patient preferences. Furthermore, the PSA test should not be used if the patient does not express a clear preference for screening.
In the second statement, it is recommended that clinicians do not screen for prostate cancer using the PSA test in men aged over 50 years who are of average risk for the disease, men aged over 69 years, or men with a life expectancy of less than 10-15 years.
They add that patients should be educated on the pros and cons of prostate cancer screening, and the conversation be recorded. In particular, patients should be told that the PSA blood test opens the door for further investigation and treatments that may cause harm, and that, for most men, the risks for harm from the test outweigh the chances of benefit.
Furthermore, among other points, the ACP emphasizes that patients should be told that the vast majority of prostate cancers are slow growing and do not cause death, and that the PSA test often does not distinguish between serious and nonserious cancer.
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By Liam Davenport, medwireNews Reporter