More Prostate Cancer Test Advice for Some Men

There's more advice on the contentious issue of prostate cancer screening: A leading group of cancer specialists says the decision hinges in part on a man's life expectancy.

Doctors should discuss the possible pros and cons of those PSA blood tests with men expected to live longer than another 10 years, the American Society of Clinical Oncology recommended Monday.

That's a contrast from guidelines issued this spring by the U.S. Preventive Services Task Force, which recommended against routine PSA screening for all men. That government advisory panel found little if any evidence that PSA testing saves lives — and said too many men suffer impotence, incontinence, heart attacks, occasionally even death from treatment of tiny tumors that never would have killed them.

In its own review, the oncologists' group ASCO concluded that doctors should discourage PSAs for men with less than 10-year life expectancy, for those very reasons.

But it didn't find the evidence as clear-cut for younger or healthier men — and released a step-by-step guide, in easy-to-understand language, to help them and their primary care physicians understand the controversy and make an informed decision. The new advice echoes guidelines from the American Cancer Society.

"This is a gray area of medicine," said Dr. Ethan Basch, a prostate cancer specialist at Memorial Sloan-Kettering Cancer Center who co-chaired ASCO's review. "That's made this a very challenging discussion, and a very challenging decision."

The guide makes clear that before men decide to have the PSA test, they should think about how they'd react to a suspicious result, and all the testing and treatment decisions that would entail.

Too much PSA, or prostate-specific antigen, in the blood only sometimes signals prostate cancer is brewing. It also can mean a benign enlarged prostate or an infection. Only a biopsy can tell. Most men will get prostate cancer if they live long enough. Some 240,000 U.S. men a year are diagnosed with it, most with slow-growing tumors that carry a very low risk of morphing into the kind that can kill.

Two huge studies, one in Europe and one in the U.S., evaluated whether routine screening can save lives. Without screening, about 5 in every 1,000 men die of prostate cancer over 10 years. The European study found PSA testing might prevent one of those deaths, while the U.S. study found no difference.

ASCO's patient guide highlights the European study results.