American College of Physicians questions prostate screening- releases new guidelines:

Jojy Cheriyan MD;MPH-Aprl08,2013

American college of physicians (ACP) released a statement today (April 8,2013) criticizing prostate screening in their official publication Annals of Internal Medicine(online before print ). ACP has been playing an integral role against overuse, excessive use and unnecessary use of medical treatments since last several years as more nationwide debates started off questioning the skyrocketing healthcare costs.

In the statement published today ACP exhorted doctors to explain in detail the limited benefits and substantial harms of prostate screening test while recommending Prostate-Specific Antigen test (PSA-test).The guidelines also include talking points for doctors.

Most prostate cancers are slow growing and do not spread beyond the prostate gland.PSA test is not a fool proof. It is possible that you can have prostate cancer when PSA is normal and no cancer when PSA level is high. PSA test cannot confirm prostate cancer. To confirm cancer biopsy of the prostate has to be done which has major risks like infection, bleeding and hospitalization.

Another fact is that not all prostate cancers need treatment. It is possible that treatments like surgery and radiation can cause more risks and side effects like urinary incontinence, sexual dysfunction and bowel problems that can persist rest of life. Most prostate cancers are not life-threatening and it is not yet proven that early detection and treatment can reduce death from prostate cancer.

In the guidelines published today ACP recommends against prostate cancer screening for average risk men younger than 50, or older than 69. For men younger than 50, the harms such as erectile dysfunction and urinary incontinence may cause more discomfort relative to any potential benefit. Men with a life expectancy of less than 10 to 15 years (or those over 70 years old) should not be tested because the harms of prostate cancer screening outweigh the benefits for this population.

To formulate the recommendations researchers from ACP's Clinical Guidelines Committee conducted a rigorous review of available guidelines from other organizations. ACP is the largest medical specialty organization and the second largest physician group in the United States.

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