Think twice about prostate cancer screening

A leading medical group says men should not routinely get a PSA blood test

Published: September 25, 2013 09:30 AM

That’s the new advice from one of the leading physician groups in the country, the American Academy of Family Physicians (AAFP). It says that there’s little evidence that the PSA blood test, a familiar part of many men’s routine physical exams, saves lives, and good evidence that it often leads to unnecessary treatment, including surgery and radiation, both of which can leave men impotent, incontinent, or both.

That advice jibes with our recent Ratings of cancer screening tests. We gave the PSA test low Ratings for men of all ages, especially those younger than 50 or older than 70.

Growing research shows that many of the cancers detected by prostate cancer screening grow so slowly that they would likely never spread beyond the gland and become deadly. But people diagnosed with prostate cancer often end up getting treated anyway, and that treatment often leads to incontinence or impotence and sometimes even deadly complications. In fact, some research suggests that as many men may die from complications of prostate cancer treatment as are saved by early diagnosis.

The AAFP is so concerned about the test that it recently added prostate cancer screening to a list of tests and treatments that doctors often recommend to patients but that aren’t supported by evidence. The group says that doctors shouldn't offer the test to men unless they are willing to have a full and frank discussion with patients in which they describe the known limitations of prostate cancer screening.

The list is part of a campaign called Choosing Wisely, a program that aims to reduce waste and harm in medical care. It is led by Consumer Reports and the ABIM Foundation, a group formed by the American Board of Internal Medicine. See the AAFP’s list.

—Joel Keehn


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