Prostate Cancer Tests as Routine Not Recommended for All Men
Top doctors are calling attention to new guidance on screening for prostate cancer—the second-leading cause of cancer deaths for American men.
The new guidelines—which are laid out in documents being made available to urologists, general MDs and the public this coming week—are significant because they endorse the use of a specific test to screen for prostate cancer—with certain caveats. The guidance, however, rejects a blanket recommendation that calls for all men over the age of 40 to receive such screenings.
"What we're saying in our guideline is that screening as a routine is not recommended in all men," according to new guidelines from the American Urological Association. A panel for the group, also known as AUA, penned the new language.
Because prostate cancer is a slow-moving disease unlike other cancers, patients and doctors must weigh the risks of testing against quality-of-life issues. And screening comes with risks including potentially unnecessary biopsies and side effects such as erectile dysfunction.
"The real issues for the panel was how to increase the benefits [of testing] and reduce the harm at the same time," according to AUA's new guidelines.
Testing Guidelines: Plenty of Opinions
AUA's new guidance recommends that all men between the ages of 55 to 69 should discuss the value and frequency of receiving Prostate-Specific Antigen, or PSA, screening because the association believes that age group is more likely to benefit from such screenings.
The new guidelines also call out and recommend that all African-American men, those males with a history of prostate cancer among their fathers, sons and brothers, and men with urinary symptoms talk to their doctors about prostate-cancer screening.
Investor Warren Buffett discovered he had prostate cancer after years of monitoring his PSA levels. A higher reading prompted a biopsy that led to the diagnosis.
Not unlike mammogram testing for breast cancer among women, there are plenty of opinions among patients and medical experts about screening for prostate cancer.
The association's guidelines on the efficacy of PSA tests contrasts with the U.S. Preventative Task Force, which last year recommended against the test being used for screening. The task force—a volunteer panel of national experts in prevention and evidence-based medicine—said the test carries a very small potential benefit and potential risks.
On the other hand, AUA's guidelines contrast with some medical practitioners, who believe all men should get a PSA test.
"We did not believe that the PSA should be disregarded. It's a useful test, it saves lives, it prevents deaths from prostate cancer," said Dr. H. Ballentine Carter, the director of adult urology at the Johns Hopkins University School of Medicine in Baltimore, and chairman of the association panel that drew up the new prostate cancer detection guideline.
(Infographic: Is Prostate Cancer Screening Right For You?)
Forget 'One Size Fits All'
Carter added the guidelines are further recognition that "a more 'one-size, fits-all' approach is probably not in the best interests of patients" when it comes to such screening tests. "We believe there was no evidence, no strong evidence of benefits of (automatic PSA screening) before age 55 and after age 70," said Carter.
The new guidance also encourages more discussion of screening benefits and risks—before any testing begins. "There wasn't as great an emphasis on shared decision-making before, and our evidence review shows that shared decision-making allowed [patients] to make an appropriate decision," Carter said.
He added prostate cancer screening is a tricky topic because "there's a common misconception that I think the public has: most people believe that it's better to diagnose the cancer early and you really (always) benefit from having a diagnosis."
(Read More: Warren Buffett Says He Has Stage 1 Prostate Cancer)
Risks Associated With Over Diagnosis
In fact, Carter said, "a large proportion of men who have a PSA test that leads to a diagnosis would never have (otherwise) known that they had that cancer ... They would have lived out their life, died from something else.
"That's a big problem that we call over diagnosis," he said.
Over diagnosis of prostate cancer can lead to biopsies and treatments for many men, who are not going to see an improvement or extension of their lives but in fact a reduced quality of life, Carter said.
Beyond unnecessary stress and worry, false test results can mean treatments with side effects that can include erectile dysfunction, and problems with urinary and bowel functions.
"Many men with prostate cancer will never know they have it unless they get tested. In these cases, symptoms or problems are more likely to result from testing and treatment than the cancer itself," according to the association's new guidelines.
Highers Risks for African-American Men
Of course, the new guidelines do not minimize the seriousness of the disease, which is more prevalent among African-American men, and men with a family history of the disease.
African-Americans face a 1-in-3 chance of being diagnosed with prostate cancer—higher than all American men, who face a 1-in-6 risk of being diagnosed. And about five out of every 100 African-American men die from prostate cancer, compared to three out of every 100 American men.
"Prostate cancer is the most commonly diagnosed and is the second leading cause of male cancer death, and there's no question that it takes peoples' lives," Carter said.
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—By CNBC's Dan Mangan. Follow him on Twitter @danpostman