ACP: Just say maybe to PSA screening

The American College of Physicians (ACP) is advising physicians to tell men between the ages of 50 and 69 of the limited benefits and potential harms of the prostate-specific antigen (PSA) test before they undergo screening, according to recommendations published April 9 in Annals of Internal Medicine.

ACP’s recommendations also suggest limiting screening in patients outside that age range, according to the article authored by Amir Qaseem, MD, PhD, MHA, and colleagues at ACP.

The two full guidance statements are as follows:

Guidance Statement 1: ACP recommends that clinicians inform men between the age of 50 and 69 years about the limited potential benefits and substantial harms of screening for prostate cancer. ACP recommends that clinicians base the decision to screen for prostate cancer using the prostate-specific antigen test on the risk for prostate cancer, a discussion of the benefits and harms of screening, the patient’s general health and life expectancy, and patient preferences. ACP recommends that clinicians should not screen for prostate cancer using the prostate-specific antigen test in patients who do not express a clear preference for screening.

Guidance Statement 2: ACP recommends that clinicians should not screen for prostate cancer using the prostate-specific antigen test in average-risk men under the age of 50 years, men over the age of 69 years, or men with a life expectancy of less than 10 to 15 years.

The guidance statements were based on an evaluation of available U.S. guidelines on prostate cancer screening, which were developed by the American College of Preventive Medicine, American Cancer Society, American Urological Association and U.S. Preventive Services Task Force.

“High-value care reflects care for which the benefits are likely to outweigh the harms and costs associated with delivering such care,” wrote the authors. “Screening with the PSA test is low-value care. The value of screening for prostate cancer in most cases is low, given that the chances of harm with screening outweigh the chances of benefit for most men and that the direct and indirect costs associated with biopsy, repeated testing, aggressive therapy, patient anxiety, and missed work are significant.”