The American Society of Clinical Oncology (ASCO) has just issued a new provisional guideline on the use of PSA testing in the assessment of risk for prostate cancer. The full text of this article is available on line.
This new provisional guidance from ASCO makes three core recommendations:
- “In men with a life expectancy < 10 years, it is recommended that general screening for prostate cancer with total PSA be discouraged, because harms seem to outweigh potential benefits.”
- “In men with a life expectancy > 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 but is associated with harms, including complications, from unnecessary biopsy, surgery, or radiation treatment.”
- ” … 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 aPSA test.”
While others may disagree, these three recommendations make perfect sense to The “New” Prostate Cancer InfoLink.
We should point out carefully that this provisional recommendation is limited to men who have never been diagnosed with prostate cancer. The role of PSA testing in the long-term management of men recently or previously diagnosed with and treated for (or being managed with) prostate cancer is not affected by this guideline.
ASCO is careful to note that the estimation and calulation of life expectancy is based on individual factors and circumstances. They point out that a number of life
expectancy calculators are publicly available. (They refer readers to the one on the Social Security Online web site as just one such example. We would point out that this particular calculator does not take any account of any such factors as current health, lifestyle, and family history that could increase or decrease life expectancy.)
Quoted in a report already up on the ABC News web site, Dr. Robert Nam, one of the co-chairs of the ASCO committee that issued this provisional guideline has said:
A lot of men that have a long life expectancy would benefit from screening, especially those that will be diagnosed with aggressive forms of prostate cancer. Men with aggressive prostate cancer can benefit from early treatment.