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The American Society of Clinical Oncology issued a new evidence-based provisional clinical opinion (PCO) on the use of prostate-specific antigen testing for prostate cancer screening. The recommendation is that physicians discuss the benefits and risks of PSA testing with their asymptomatic male patients who have life expectancies of more than 10 years; for men with shorter life expectancies, though, the risks outweigh the benefits, the PCO states.


The benefits include identifying higher-risk prostate cancer earlier when treatment may be more effective, while the risks include over-diagnosis, unnecessary biopsy and treatment, and treatment side effects.

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In the PCO (JCO 2012;30:3020-3025), ASCO notes that this guidance differs from recommendations issued in May by the U.S. Preventive Services Task Force, which concluded that routine PSA testing is not recommended for any asymptomatic men.


"For men with a longer life expectancy, our assessment of the evidence shows the balance of risks and benefits is less clear, and that well-informed conversations between men and their physicians remain worthwhile about harms, potential benefits, and appropriate management strategies if prostate cancer is found," Ethan Basch, MD, Co-Chair of the ASCO panel and a prostate cancer specialist at Memorial Sloan-Kettering Cancer Center, said in a news release.


ASCO also released a new, detailed decision aid to help men and their physicians understand the risks and benefits of screening, and decide if PSA testing is the appropriate choice-available at


"Our critical review of the evidence, including data on younger subpopulations of men, shows that PSA testing should not be discounted," said the other Co-Chair, Robert Nam, MD, a uro-oncologist at the Odette Cancer Centre at Sunnybrook Health Science Centre of the University of Toronto.


"We recognize that many want this debate settled, and want the answer to be clear-cut. But it isn't. Until it is, we think physicians and men with longer life expectancies should be aware of the full scope of evidence on PSA testing for prostate cancer screening so they can make informed and shared decisions about the right course of action.


"Our goal is to help ensure that PSA testing is used intelligently and selectively, by testing and then treating only appropriate patients."


Basch continued, "As the organization representing physicians who counsel and treat men with prostate cancer, we see the impact of screening and treatment decisions every day, and felt it was our responsibility to conduct a rigorous analysis of the available data to help guide this very important decision for many men.


"Our approach is a balanced one that takes into consideration the life expectancy of the patient as well as the values and preferences of individual men. We also advocate for the use of evidence-based decision aids, research to improve screening methods, and reduction of overtreatment of likely insignificant cancers."