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Experts Back Away From Annual PSA Test
Date:4/27/2009

Men should have a 'baseline' prostate cancer screen at 40, but yearly PSA may not be necessary, guidelines say

MONDAY, April 27 (HealthDay News) -- New guidelines on prostate cancer screening suggest that annual PSA blood tests might not be necessary for many men, but the same guidelines call for a "baseline" PSA test at the age of 40, rather than 50.

A prostate-specific antigen (PSA) test to detect early signs of prostate cancer should be offered to "well-informed men aged 40 and older who have a life expectancy of 10 years," state clinical guidelines issued Monday by the American Urological Association at its annual meeting in Chicago.

Noting that the issue of PSA testing and how it should be used to guide treatment "is highly controversial," the association still stated that the test, "when offered and interpreted appropriately, may provide important information for the diagnosis, pre-treatment staging or risk assessment or post-treatment monitoring of prostate cancer."

But it's important that "the risks and benefits of PSA screening be discussed with men before the test is done," said Dr. Peter Carroll, chairman of the department of urology at the University of California, San Francisco, who headed the committee that drew up the new guidelines.

Those risks can include impotence and incontinence caused by unnecessary surgery.

The recommendation that a first PSA test be offered to men at 40 should help doctors spot high-risk patients more readily, however. "PSA at that age is strongly predictive of the future risk of prostate cancer," Carroll said. "Later detection in the 50s, when the cancer would be more advanced, could be avoided."

The guidelines also recognize that many prostate cancers grow so slowly that they are of no risk, he said. Further steps after detection of an elevated level of PSA, a protein produced by the prostate, should require consideration of "other risk factors
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