The American Urological Association pulled back Friday, May 3rd, 2013, from its strong support of prostate cancer screening, saying that the testing should be considered primarily by men aged 55 to 69.
The association had staunchly defended the benefits of screening men with the prostate test, even after a government advisory committee, the United States Preventive Services Task Force, said in 2011 that healthy men should not be screened because far more men would be harmed by unnecessary prostate cancer treatments than would be saved from death.
But in new guidelines issued Friday, the urology association said that routine screening is no longer recommended for men 40 to 54 years old at average risk of getting prostate cancer. Screening is also not recommended for men 70 and older.
The guidelines say screening might be beneficial for men 55 to 69, who have a greater risk of cancer, but even here they do not recommend testing. Instead, the association urges men to discuss the benefits and harms with their doctors. And if they do choose screening, an interval of two years rather than annually would be better.
“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,'’ Dr. H. Ballentine Carter, a professor of urology and oncology at Johns Hopkins University and chairman of the committee that drafted the guidelines, said in a statement Friday.
The urology association’s previous recommendation, issued in 2009, was that blood testing for P.S.A., which stands for prostate-specific antigen, should be offered to men starting at age 40.
When the government advisory task force recommended against screening, the association expressed outrage and began a lobbying effort, urging the public to try to have the recommendation reversed. One doctor, speaking for the association, characterized the task force recommendation as “flawed, dangerous and catastrophic for men.'’
But some prostate cancer experts say the association risked losing credibility had it stuck to its recommendations for widespread screening. The new guidelines, they say, represent a sort of compromise, aimed at preserving P.S.A. screening by recommending more moderate use.
“The A.U.A. is not dismissing the P.S.A. test as the task force has done,'’ said Dr. Philip W. Kantoff, a prostate cancer specialist at the Dana-Farber Cancer Institute in Boston. “There should be a more reasonable approach to the use of P.S.A.'’ Dr. Kantoff is an oncologist, not a urologist, but was invited to serve on the panel that came up with the new guidelines.
The problem with screening is that levels of P.S.A. in the blood can be elevated for reasons having nothing to do with prostate cancer. That leads numerous men to have unnecessary biopsies, which can cause pain and infections. And biopsies find many cancers that would be so slow growing they would never harm the man. However, since it is difficult to determine the dangerous from the nonaggressive tumors, most men undergo surgery or radiation treatments and then suffer from side effects such as incontinence and erectile dysfunction.
The task force, citing the results of some clinical trials, said that P.S.A. screening saved few lives but subjects many men to unpleasant side effects.
In its guidelines on Friday, the association said that for men 55 to 69, screening would prevent one prostate cancer death for every 1,000 men screened over a decade.
The guidelines say that some men at higher-than-average risk of getting prostate cancer, such as those with a family history, could discuss the benefits and harms of starting screening at an age earlier than 55.
Some other medical societies have issued guidelines that also urge moderate use of the P.S.A. test but the urological association is influential because its members treat many of the cases of prostate cancer. The advent of P.S.A. testing led to a big jump in the number of diagnoses of prostate cancer, increasing the business of urologists.
Dr. Otis W. Brawley, the chief medical officer of the American Cancer Society, said that the new guidelines were “a wonderful thing'’ but that he was concerned that many urologists would continue regular testing anyway. He said the urology association’s new stance is now close to that of the American Cancer Society.
Dr. Brawley has been a critic particularly of mass screening campaigns, such as those held at shopping malls or fairgrounds. “There has been a lot of money made by hospitals and clinics doing these mass screenings,'’ he said.
The new urology guidelines, in that they encourage careful discussions with a man’s doctor, would seem to discourage such mass screening events, Dr. Brawley said.
The association had staunchly defended the benefits of screening men with the prostate test, even after a government advisory committee, the United States Preventive Services Task Force, said in 2011 that healthy men should not be screened because far more men would be harmed by unnecessary prostate cancer treatments than would be saved from death.
But in new guidelines issued Friday, the urology association said that routine screening is no longer recommended for men 40 to 54 years old at average risk of getting prostate cancer. Screening is also not recommended for men 70 and older.
The guidelines say screening might be beneficial for men 55 to 69, who have a greater risk of cancer, but even here they do not recommend testing. Instead, the association urges men to discuss the benefits and harms with their doctors. And if they do choose screening, an interval of two years rather than annually would be better.
“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,'’ Dr. H. Ballentine Carter, a professor of urology and oncology at Johns Hopkins University and chairman of the committee that drafted the guidelines, said in a statement Friday.
The urology association’s previous recommendation, issued in 2009, was that blood testing for P.S.A., which stands for prostate-specific antigen, should be offered to men starting at age 40.
When the government advisory task force recommended against screening, the association expressed outrage and began a lobbying effort, urging the public to try to have the recommendation reversed. One doctor, speaking for the association, characterized the task force recommendation as “flawed, dangerous and catastrophic for men.'’
But some prostate cancer experts say the association risked losing credibility had it stuck to its recommendations for widespread screening. The new guidelines, they say, represent a sort of compromise, aimed at preserving P.S.A. screening by recommending more moderate use.
“The A.U.A. is not dismissing the P.S.A. test as the task force has done,'’ said Dr. Philip W. Kantoff, a prostate cancer specialist at the Dana-Farber Cancer Institute in Boston. “There should be a more reasonable approach to the use of P.S.A.'’ Dr. Kantoff is an oncologist, not a urologist, but was invited to serve on the panel that came up with the new guidelines.
The problem with screening is that levels of P.S.A. in the blood can be elevated for reasons having nothing to do with prostate cancer. That leads numerous men to have unnecessary biopsies, which can cause pain and infections. And biopsies find many cancers that would be so slow growing they would never harm the man. However, since it is difficult to determine the dangerous from the nonaggressive tumors, most men undergo surgery or radiation treatments and then suffer from side effects such as incontinence and erectile dysfunction.
The task force, citing the results of some clinical trials, said that P.S.A. screening saved few lives but subjects many men to unpleasant side effects.
In its guidelines on Friday, the association said that for men 55 to 69, screening would prevent one prostate cancer death for every 1,000 men screened over a decade.
The guidelines say that some men at higher-than-average risk of getting prostate cancer, such as those with a family history, could discuss the benefits and harms of starting screening at an age earlier than 55.
Some other medical societies have issued guidelines that also urge moderate use of the P.S.A. test but the urological association is influential because its members treat many of the cases of prostate cancer. The advent of P.S.A. testing led to a big jump in the number of diagnoses of prostate cancer, increasing the business of urologists.
Dr. Otis W. Brawley, the chief medical officer of the American Cancer Society, said that the new guidelines were “a wonderful thing'’ but that he was concerned that many urologists would continue regular testing anyway. He said the urology association’s new stance is now close to that of the American Cancer Society.
Dr. Brawley has been a critic particularly of mass screening campaigns, such as those held at shopping malls or fairgrounds. “There has been a lot of money made by hospitals and clinics doing these mass screenings,'’ he said.
The new urology guidelines, in that they encourage careful discussions with a man’s doctor, would seem to discourage such mass screening events, Dr. Brawley said.
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