According to newly revised guidelines from the American Cancer Society (ACS), men should discuss the benefits and risks of prostate cancer screening with their doctors. While this is not a radical change from the previous recommendations, the new guidelines offer clearer guidance on what should be discussed. The revised recommendations, last updated in 2006, are based, in part, on early findings from two large American and European studies that looked at whether prostate cancer screening with the prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) saves lives.
In the American study, the researchers found little difference in prostate cancer death rates between two groups of men who had been randomized receive either “usual care” or annual PSA tests for 6 years and DRE every year for 4 years. In the European trial, researchers randomly assigned more than 175,000 men to either a control group or a screening group. Men in the screening group had PSA tests on average every 4 years and a DRE twice over that period of time. After approximately 9 years, the researchers found that screening reduced the rate of prostate cancer death by 20%. But they also found that 48 men would need to be treated to prevent one death from prostate cancer.
Because of these complex issues, the revised guidelines recommend that men use decision-making tools to help them make an informed choice about testing. The guidelines also identify the type of information that should be given to men to help them make this decision. Recognizing that physicians may be unable to invest greater amounts of time in such educational efforts, the ACS also urged greater use of education specialists, pamphlets, videos, and other materials to explain the risk-benefit trade-offs.
The ACS recommends that men who choose to be tested should get an annual screening if their level of prostate-specific antigen, or PSA, is 2.5 nanograms per milliliter (ng/mL) or higher. But men whose PSA is under that threshold can be safely screened every 2 years. Men with a PSA level of 4.0 ng/mL or higher should consider getting further evaluation, such as a biopsy. Previous guidelines had suggested that men with a PSA of less than 4.0 ng/mL should be screened annually. And, as before, men should start talking about the possibility of screening with their healthcare provider at the age of 50 if they are at average risk, and earlier if they are at higher risk.
The guidelines also call for cutbacks in community screening programs because such educational efforts are rarely, if ever, incorporated; they also place less emphasis on the importance of DRE due to a lack of evidence that it saves lives.