Physician Group Recommends Against PSA Tests

Prostate cancer screening recommendations released by American College of Physicians

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) If you’re a man – or a woman for that matter – you’re probably confused about cancer screenings. The recommendations for prostate cancer screenings have been all over the place.

But wait! The confusion isn’t over yet.

The American College of Physicians (ACP) is now recommending that men between the ages of 50 and 69 talk to their doctors about “the limited benefits and substantial harms of the prostate-specific antigen (PSA) test.”

The group is calling for shared-decision making between doctors and patients. According to the ACP, doctors should not recommend PSA testing unless a patient asks for it after a thorough discussion of the risks and benefits.

A prostate cancer specialist in Austin, Texas couldn’t disagree more with these new recommendations.

"Talk with your physician about prostate cancer screening."

The ACP has released its "Screening for Prostate Cancer: A Guidance Statement from the American College of Physicians," which recommends against prostate cancer screening with PSA for most men.  

In a press release announcing the publication of the new recommendations, ACP president David L. Bronson, MD, FACP, said, "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."

In a statement, the organization said, “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." 

Amir Qaseem, MD, PhD, MHA, FACP, Director of Clinical Policy at the ACP, said, “A small number of prostate cancers are serious and can cause death. 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."

Radiation oncologist Stephen Brown, MD, of Austin Cancer Centers, disagrees vehemently. “The element of harm is overstated and magnified in excess of reality in the ACP recommendations for PSA screenings. This is a simple blood test. PSA is an analytic tool employed by physicians to screen men in order to determine if further evaluation by examination and consideration of biopsy is indicated,” Dr. Brown told dailyRx News. 

“PSA does not lead to an automatic biopsy, which does not lead to automatic diagnosis and treatment. So the correlation is disproportionately exaggerated in an attempt to create fear in the public mind, which shall in return lead to men developing advanced prostate cancer with higher death rates,” Dr. Brown said.

The new ACP recommendations are based on problems – harms – associated with the process of diagnosing and treating prostate cancer. These harms include:

  • Difficulty in accurately interpreting PSA results. The test can show high PSA levels associated with other conditions such as an enlarged prostate, or can miss cancers that are present.
  • Referral to possibly unnecessary biopsies. PSA tests that are unclear can lead to unnecessary biopsy (taking tissue samples from within the prostate), a procedure that carries some risk of infection, bleeding or hospitalization.
  • Treating prostate cancer with surgery, radiation and/or hormone therapy can impact a man’s sexual function, urinary and bowel control.

Dr. Brown said, “The basis for preventative medicine with a disease process which we do not know the origin of is screening. In the US, we have been screening men for prostate cancer since 1988 when PSA became commercially available."

He continued, “Oncology screening provides earlier diagnosis and higher cure rates for the disease process. To apply the data generated in the era of active screening in an attempt to make recommendation of minimized screening is unfounded."

"The data should be applied to pre-PSA death rates for prostate cancer which were higher,” Dr. Brown said.

ACP President, Dr. Bronson, said that these recommendations may change as studies are ongoing regarding the benefits and harms of screening. "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 requested."

The recommendations were published April 8 in the Annals of Internal Medicine, an ACP publication. Several of the authors disclosed potential conflicts of interest, including employment with Informed Medical Decisions Foundation and Veterans Affairs, royalties from Health Dialog, consultancy with ECRI Institution and various research grants.

Reviewed by: 
Review Date: 
April 8, 2013
Last Updated:
April 8, 2013