ASCO Expert Panel Concludes Evidence Supports Physician Discussion of PSA Testing for Men with Longer Life Expectancies

ASCO has issued a new evidence-based provisional clinical opinion (PCO) on the use of prostate-specific antigen (PSA) testing for prostate cancer screening. To facilitate informed decisions, ASCO also released a new, detailed decision aid to help men and their physicians understand the risks and benefits of screening, and decide if PSA testing is the appropriate choice. 

The PCO recommends that physicians discuss the benefits and risks of PSA testing with their asymptomatic male patients who have life expectancies of greater than 10 years, but states that the risks likely outweigh the benefits for men with shorter life expectancies. The benefits include the identification of higher-risk prostate cancer earlier, when treatment may be more effective, while the risks include overdiagnosis, unnecessary biopsy and treatment, and treatment side effects.

This guidance differs from recommendations issued in May 2012 by the U.S. Preventive Services Task Force (USPSTF), which recommends against PSA-based screening for prostate cancer.

Specifically, the PCO recommends the following:

• In men with a life expectancy less than or equal to 10 years, it is recommended that general screening for prostate cancer PSA testing be discouraged. For these men, the evidence of harm seems to outweigh potential benefits.
• In men with a life expectancy of greater than 10 years, it is recommended that physicians discuss with their patients whether PSA testing for prostate cancer screening is appropriate for them. PSA testing may save lives for this group of men, but is also associated with harms, including complications from unnecessary biopsy, surgery, or radiation treatment for cancers that may be slow-growing and not ultimately life-threatening.
• It is recommended that information written in lay language be available to clinicians and their patients to facilitate the discussion of the benefits and harms associated with PSA testing before the routine ordering of a PSA test.

The decision aid and the guideline are available at www.asco.org/pco/psa. ■