In newly released guidelines by the American Urological Association (AUA), now healthy men under 55 don't need routine annual prostate cancer screening.
The new guideline recommends that routine screening is no longer required for men 40 to 54 years old at average risk of getting prostate cancer. Screening is also not recommended for men 70 and older.
"It's time to reflect on how we screen men for prostate cancer and take a more selective approach in order to maximize benefit and minimize harms," Dr. H. Ballentine Carter, a professor of urology and oncology at Johns Hopkins University and chairman of the committee that drafted the guidelines.
The guideline makes the following specific statements:
- PSA screening in men under age 40 years is not recommended.
- Routine screening in men between ages 40 to 54 years at average risk is not recommended.
- For men ages 55 to 69 years, the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, shared decision-making is recommended for men age 55 to 69 years that are considering PSA screening, and proceeding based on patients' values and preferences.
- To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce over diagnosis and false positives.
- Routine PSA screening is not recommended in men over age 70 or any man with less than a 10-15 year life expectancy.
This is a major difference from the guidelines issued last year by the US Preventative Services Task Force (USPSTF), which recommended against any routine use of the PSA test, concluding that any benefit is outweighed by harm.
