“Men ages 55 to 69 who are considering PSA screening should now speak with their physician about the benefits and the harms of testing to determine the best course of action,” the group said in the guidelines.
Once widely used to detect early stage prostate cancer, PSA screening tests have come under fire for fueling overtreatment and unnecessary complications, including sexual dysfunction and incontinence.
The newly issued recommendations are far more stringent than the AUA's earlier guidance, issued in 2009, which stated that the PSA test should be offered to men aged 40 and older who have at least 10 years life expectancy.
“The new guideline is significantly different than previous guidance inasmuch as it was developed using evidence from a systematic literature review rather than consensus opinion; provides rating and interpretation of the evidence based on randomized controlled trials with modeled and population data as supporting evidence; and develops statements that do not go beyond the available evidence,” the AUA said in a news release.
The AUA's move came in the wake of several other groups that have recently advocated for limited use of PSA tests. On April 8, the American College of Physicians issued new screening guidelines, advising members against using the test for men younger than 50 and older than 69, or for men whose life expectancy is less than 10 years.
And in May 2012, the U.S. Preventive Services Task Force recommended against PSA screening for men of any age, citing the test's limited benefits and high related rates of unnecessary surgeries and complications.
“No studies show any benefit in overall death rates,” the USPSTF said.
The AUA decried the USPSTF's conclusion, calling its blanket recommendation “inappropriate and irresponsible.”
But in their latest practice guidelines, the AUA took a more measured approach, arguing for the benefits of PSA screening but also acknowledging the potential risks associated with it.
“There is general agreement that early detection, including prostate-specific antigen screening, has played a part in decreasing mortality from prostate cancer,” Dr. H. Ballentine Carter, chair of the AUA panel that developed the guideline, said in the release. “The randomized controlled trials are more mature at this point and there is more data available today than there was in 2009. It's time to reflect on how we screen men for prostate cancer and take a more selective approach in order to maximize benefit and minimize harms.”
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