Doctor Group Rejects Regular Prostate Testing

The American College of Physicians, in a break with widespread practice, has concluded there is no evidence that patients benefit from routine screening for prostate cancer and recommends against regular testing for all men.

Because of uncertainties in the reliability of the tests and the substantial risks of aggressive early treatment, the organization decided screening should be undertaken as an “individualized decision” of each patient after counseling by physicians. The new guidelines are published in today’s Annals of Internal Medicine.

In contrast, the American Cancer Society, American College of Radiology and American Urological Assn. recommend that men begin undergoing annual digital exams at age 40. The cancer society recommends also getting annual prostate-specific antigen (PSA) tests beginning at age 50.

Increased PSA screening, which became broadly available in the late 1980s, reportedly has led to a sixfold increase in surgical removals of the prostate, a gland that lies below the bladder and encircles the urethra.

In many cases, patients and doctors have wondered whether the risks of early aggressive treatment--including impotence, urinary incontinence, bowel problems and even death--may outweigh the threat of prostate cancer, which often develops so slowly that sufferers die of some other cause before the cancer becomes a severe problem.