PSA Testing May Be Appropriate for Some Men

PSA Testing May Be Appropriate for Some Men.

The American Society of Clinical Oncology (ASCO) has released a Provisional Clinical Opinion (PCO) suggesting that that men with a longer life expectancythose with at least 10 more years to livediscuss with their physician the potential risks and benefits of prostate-specific antigen (PSA) testing. Conversely, men with a poorer outlook may want to avoid PSA testing. The opinion was published early online in the Journal of Clinical Oncology.[1]

Screening for prostate cancer is a complicated and controversial topic. There is still no clear evidence that screening for prostate cancer reduces the risk of death from this disease.[2] For men who choose to be screened, screening often involves a blood test to measure levels of a protein known as prostate-specific antigen (PSA). PSA is a protein that is normally secreted and disposed of by the prostate gland. High PSA levels may indicate the presence of prostate cancer cells or other noncancerous prostate conditions.

The U.S. Preventive Services Task Force (USPSTF) recently drafted a grade D recommendation against prostate-specific antigen (PSA) screening for prostate cancer.[3] That recommendation stirred the debate about the risks and benefits of screening for prostate cancer.

To evaluate the risks and benefits of PSA testing, ASCO reviewed the same data used by the USPSTF in drafting their recommendation. The review included two main studies, one European and one American, which yielded mixed results. Upon reviewing the data, ASCO concluded that PSA testing may save lives in men who have at least 10 years left to live; however, it is also associated with some risks, including complications from unnecessary biopsy, surgery, or radiation treatment.

In short, the ASCO recommendation calls for informed decision makingsuggesting that men should be informed about the risks and benefits of the PSA test and should be allowed to make a choice. Mass screening of all men appears to be unnecessary, but a select group of men might benefit from the screening test.

ASCO recommends:

  • Men with less than 10 years left to live should be discouraged from undergoing PSA testing.
  • Men with at least 10 more years to live should be informed about PSA testingincluding the risks and benefitsand allowed to make a choice.
  • Clinicians should make informationwritten in lay languageavailable to patients in order to facilitate discussion and informed decision-making.

References:

[1] Basch E, Oliver TK, Vickers A, et al. Screening for prostate cancer with prostate-specific antigen testing: American Society of Clinical Oncology Provisional Clinical Opinion. Journal of Clinical Oncology. Published early online July 16, 2012. doi: 10.1200/JCO.2012.43.3441

[2] Andriole GL, Crawford ED, Grubb RL et al. Prostate cancer screening in the randomized Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial: Mortality results after 13 years of follow-up. Journal of the National Cancer Institute. Early online publication January 6, 2012.

[3] Prasad SM, Drazer MW, Huo D, et al. 2008 US Preventive Services Task Force recommendations and prostate cancer screening rates. JAMA. 2012; 307(16): 1692-1694.

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