New advice on prostate screening: Healthy men under 55 don’t need annual test

A new group of health experts — urologists this time — is offering recommendations in the evolving debate over prostate cancer screening.

For years, older men were counseled to get the prostate-specific antigen blood test every year to screen for prostate cancer. Then, in 2012, a national panel of health professionals — the U.S. Preventive Services Task Force — concluded that many men are harmed as a result of routine prostate cancer screening

Critics argue that too frequent screening often leads to treatments that can cause impotence or incontinence. Even further testing — or a biopsy — comes with complication risks including infection.

“There’s always been knowledge that there’s a certain group of men that didn’t need to be screened,” said Eric Horwitz, an oncologist at Fox Chase Cancer Center. “And if you get diagnosed with prostate cancer, there’s also a certain group of men that don’t need to be treated. The question — and the problem — has been how do we identify who these men are?”

This week, the American Urological Association, directed its advice to men age 55 to 69, and urged them to speak with a doctor about the benefits and potential harm of testing. The new guidelines from the doctors group say healthy men under 55 don’t need routine annual screening.

Horwitz says he and other physicians are having more of those conversations with patients. As the debate evolved in recent years, many men have already decided to limit how often they get tested, Horwitz said.

“Both in the Philadelphia area, and across the United States, there are fewer instances of prostate cancer being diagnosed,” he said. “I think that has to do with changes in screening and fewer biopsies are being done. It’s actually something that we are all talking about and all noticing.”

University of Pennsylvania urologist David Lee said the PSA is still a valuable tool, but smarter screening is needed.

“There have been studies which look at population groups, and then the value of screening PSAs, say a single screening test at age 40, or age 60,” Lee said. “It has been shown to be actually very strong predictor of how men will do over the course of their lifetime.”

Both physicians said discussions about prostate cancer screening should include talks about a patient’s personal risk and family cancer history.