Men looking for easy answers on when to be tested for prostate cancer won't find them anytime soon.
For the first time since 2001, the American Cancer Society has updated its advice on prostate cancer screening. And the upshot is that now more than ever men need to talk with their doctors about whether having a PSA test makes sense for them.
Doctors and patients need to decide together what to do because balancing the benefits and risks from results of the simple blood test hinge on the health particulars.
For those reasons, the cancer group comes out against the typical kinds of prostate cancer screening fairs and community events that encourage all sorts of men to get screened. The group says those events only make sense if they can offer in-depth discussion of risks and benefits and the right kinds of follow-up. Because men 65 and up are part of Medicare, they should generally skip the fairs and see their doctors.
Routine testing isn't recommended, advice that hasn't changed, the ACS said. And, the cancer group now recommends that when men can't decide whether or not to have a PSA test, doctors should use their discretion. Previous advice recommended that wafflers should get tested.
When should men start talking with doctors about screening? Age 50 is the right starting point for most, though men at higher risk, such as African Americans, should start earlier.
The questions about the value of PSA testing persist because many prostate cancers grow slowly and don't pose a significant health risk, especially for older men. Most men with prostate cancer die from something else, even before they ever show symptoms. While the PSA test itself is safe, biopsies done afterward carry risks. And treatments for prostate cancer can have complications, such as impotence and incontinence.
Two big studies—one performed in Europe and the other in the U.S.—helped shaped the latest advice.
The European study, published last year, found screening cut the death rate from prostate cancer by 20 percent. But, 1410 men would have to be screened and 48 cases of prostate cancer would have to be treated to prevent each prostate cancer fatality.
The U.S. study, also published in 2009, found a "very low" death rate from prostate cancer and that annual screening didn't change it.
For more on the pros and cons of prostate cancer screening, check out this video from Dr. Michael Barry, president of the nonprofit Foundation for Informed Medical Decision Making.