Q & A: Prostate Cancer Screeing Guidelines

Q: What's different about the new prostate cancer screening guidelines?

Prostate cancer remains the most commonly diagnosed cancer in U.S. men and the second-leading cause of cancer deaths in men in this country. But far more men are diagnosed with prostate cancer than eventually die from the disease.

We have used the PSA (prostate-specific antigen) blood test for over 20 years in the belief that it diagnoses prostate cancer early and avoids deaths from the disease. But recent research has led many experts to conclude that we can’t say with certainty that the PSA test actually saves lives.

In light of that research and other long-standing concerns, the American Cancer Society recently updated its screening guidelines for prostate cancer.

A key part of the new guidelines is that men must have a discussion with their health care professional before getting the PSA test in an effort to clearly convey what we know and don’t know about the value of the test and early detection for prostate cancer. Men must understand the possible benefit from the PSA test—namely, that it may save lives from the disease—but also the possible harm of unnecessary treatment, including treatment side effects such as urinary incontinence and sexual difficulties.

The ACS recommends that men ages 50 and over who are at average risk with a 10-year life expectancy should talk to their doctor about the PSA test. Men at higher risk—such as African-American men and men with first-degree relatives diagnosed with prostate cancer before age 65—should have these conversations during their 40s.

Another key feature of the guidelines is that the ACS discourages men from getting tested in a setting, such as mass screenings at health fairs, where such conversations with a health professional are not possible and follow-up for abnormal results is not assured.

The guidelines now say men with a PSA level below 2.5 ng/ml only need to be tested every other year instead of annually. If someone has a PSA between 2.5 and 4 ng/ml, the man and his doctor should take a close look at the man’s health status and risk profile to determine whether he should be referred for further evaluation. If the PSA is over 4 ng/ml, further evaluation is appropriate.

These guidelines are complex. If you need help understanding what you should do, talk with your health professional. You can also contact the American Cancer Society at 800-227-2345.

—Len Lichtenfeld, MD, is deputy chief medical officer for the American Cancer Society