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Urologists echo call for discussion before PSA test

By Genevra Pittman

NEW YORK (Reuters Health) - Urologists fell in line with other doctor groups on Friday in recommending careful consideration and discussion when it comes to screening for prostate cancer, rather than a gung-ho approach.

At its annual meeting in San Diego, California, the American Urological Association (AUA) recommended against screening average-risk men under age 55 or any man over 70 using prostate-specific antigen, or PSA, blood tests.

At in-between ages, the group said each man should weigh the benefits and harms of screening and treatment and decide with his doctor what approach best fits his values.

For those who do choose screening, it added, an interval of every two years may be better than annual tests.

"I look upon this guideline… as the beginning of a targeted-based screening," said Dr. H. Ballentine Carter, chair of the panel that developed the guidelines and a urologist and oncologist at Johns Hopkins Hospital in Baltimore.

"Instead of a one-size-fits-all approach, we're trying to emphasize that there is a group of men between age 55 and 69 that are much more likely to benefit," he told Reuters Health.

A year ago, the U.S. Preventive Services Task Force, a government-backed panel, created controversy by recommending against prostate cancer screening for average-risk men of all ages.

Since then, other professional organizations have taken a skeptical but less decisive view toward PSA testing.

Last month, for example, the American College of Physicians said that for men in their 50s and 60s, doctors should base screening decisions on the patient's risk for prostate cancer, his general health and preferences and on a discussion of screening's potential benefits and harms (see Reuters Health story of April 8, 2013 here: http://reut.rs/12C8KfH).

About 239,000 men are expected to be diagnosed with prostate cancer in the U.S. in 2013 and about 30,000 will die of the disease, according to the American Cancer Society.

Evidence suggests that screening with PSA tests is tied to a small reduction in deaths - about one per 1,000 men screened over a decade, the AUA reported. But some results are also false-positives and spur unnecessary further testing and treatment, which can leave men impotent and incontinent.

In evaluating the data, Carter said, "The evidence for the benefits of prostate cancer screening was moderate, but the quality of evidence on the harms was high."

He said it's important to have shared decision-making between patients and doctors when it comes to PSA tests, as men may weigh the pluses and minuses of screening differently.

"I think men need this information, they deserve to have this information and when they get it, some men will take the same information and decide they want to get screened" and others won't, he said.

Dr. Richard Greenberg, head of urologic oncology at Fox Chase Cancer Center in Philadelphia, agreed with the new guidelines but is still concerned about whether they will reach men and their primary care doctors.

"If you don't get people to buy into the guidelines and understand and read the guidelines, it doesn't really help us very much," said Greenberg, who wasn't part of AUA's guideline writing team.

He said the PSA test is "not a great test," but that it has made it rare for oncologists to see advanced prostate cancer.

"To just say, ‘You shouldn't do screening because there's no benefit,' is I think the wrong message," Greenberg told Reuters Health.

Rather, he agreed with Carter that men should understand everything that comes with screening - both the pluses and minuses - and discuss it with their doctor.

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