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No More Routine PSA Testing says Urology Group: Here's why

Kathleen Blanchard's picture
New guidelines issued by American Urological Association for PSA testing

Screening men for prostate cancer with a PSA test has been a routine that experts have defended as a valuable tool for detecting cancer. But now the American Urological Association (AUA) says there are good reasons not to have the test performed as a routine part of your exam.

Push for PSA not scientifically sound

So why has the group changed their mind about the value of routine prostate cancer screening that they previously defended?

There are several reasons, the group says, that include:

  1. Harm that comes from undergoing treatment for cancer
  2. PSA screening before age 55 has the least benefit, based on the group’s review
  3. Evidence shows men age 55 to 69 who are screened annually have higher chance of overdiagnosis of cancer and harm from treatment. The recommendation is to discuss with your physician and wait 2 years between tests.
  4. Prostate cancer detected early but without symptoms would not normally lead to treatment.
  5. “PSA screening will correctly predict the presence of prostate cancer in about one of every four biopsies”, the group writes. Few men over age 70 would benefit from prostate cancer screening and treatment unless life expectancy is greater than 10 to 15 years. The same life expectancy guideline can be applied to men age 55 to 69.

That doesn't mean men should not discuss the risks and benefits of the test with their doctors.

The panel writes: “Men considering a screening test for prostate cancer should be aware of several facts that may influence their decision whether to obtain a PSA test or not. First, they should be aware that their risk of dying of prostate cancer is about 3% over a lifetime on average.”

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They also note that approximately 80 percent of PSA tests will yield false positive results. Conversely, prostate cancer can still be missed with the test.

They also say there is no level of PSA below which a man can be told they do not have prostate cancer.

The AUA reached their conclusions through a review of existing literature conducted by an independent panel that included articles published in English between 1995 and 2013.

In summary, the panel recommends:

  • Against PSA screening in men younger than age 40
  • No routine PSA for average risk men age 40 to 55. For those at high risk, the decision for screening should be individualized.
  • If you are age 55 to 69, speak with your doctor about the risks and benefits. The decision for PSA testing in this age group should be based on a man’s “values and preferences”.
  • If you do choose to have a PSA test, the preference may be to wait 2 years for the next test to reduce the risk of overdiagnosis and false positive tests.

Past studies have also suggested not all prostate cancer needs to be treated.

The new PSA recommendations are also in line with the Institute of Medicine and the U.S. Preventive Task Force. The bottom line if you want a PSA test every year, talk to your doctor, understand the potential risks and know that the test is not perfect. Mass screening for prostate cancer is no longer recommended routinely.