Most men don't need routine PSA tests

The prostate-specific antigen (PSA) blood test has become standard in checkups for men, especially those over 50. Now a government advisory body has proposed guidelines that advise against it for most men.

The draft recommendations, released in October by the U.S. Preventive Services Task Force, were based on an exhaustive review of the scientific literature on the PSA test, which screens for prostate cancer. It concluded that the test was more likely to lead to substantial harm than to save lives. That may be in part because the test can't differentiate between aggressive and non-aggressive cancers, so many men end up having surgery and radiation needlessly, exposing them to potentially devastating side effects. Up to five men in 1,000 will die within a month of prostate cancer surgery, the task force said. Another 10 to 70 will suffer dangerous complications. And at least 200 of every 1,000 men treated by surgery or radiation will experience urinary incontinence, bowel dysfunction, or impotence.

Those serious risks might be acceptable if PSA screening clearly saved lives. But the largest clinical studies to date have  found no statistically significant reduction in prostate cancer deaths among men who had the PSA test compared with men  who didn't.

Bottom line. We stand by our previous advice: Men 75 and older should skip the PSA test. Others should carefully weigh its questionable benefits against its well-established risks before agreeing to have it.