In May, after decades of supporting early and regular prostate-cancer screening, the American Urological Association made a surprising U-turn, saying testing should mainly be done on men aged 55 to 69. The standard for prostate testing has long been a shotgun approach, advocated for patients as young as 40 and into their 70s.
The problem: Blood testing for PSA, or prostate-specific antigens, is fairly inaccurate. This produces millions of false positives, which can lead to painful biopsies, the unnecessary removal of the prostate, and radiation treatment, which can cause erectile dysfunction and incontinence. “It is a good, appropriate move,” says Dr. Robert Mordkin, Chief of Urology and Director of Robotic Surgery at the Virginia Hospital Center, and a supporter of PSA testing. “It sends the correct message that PSA is far from a perfect test, and we should not over-rely on it. Yet it is still better than nothing, and is a useful tool when correctly applied and interpreted.”
The American Cancer Society’s chief medical officer, Dr. Otis Brawley, a longtime critic of PSA testing, praised the new guidelines as “truly consistent with the state of the science.” The new guidelines say that men between 55 and 69 should discuss the benefits and harms of testing with their doctors; if they choose to be tested, they should have it done every two years, not annually as earlier recommended. Those who should not be tested: men under 40, men 40 to 54, unless they have a family history of the disease, and finally men over 70 – the reason being that they statistically have less than 10 to 15 years of life expectancy anyway, so they can just skip it altogether.