In a guidance statement published Tuesday in the Annals of Internal Medicine, the American College of Physicians (ACP) joined the heated discussion on PSA testing by endorsing a shared decision making approach for prostate cancer screening. The ACP Clinical Guidelines Committee developed this guidance statement after reviewing current guidelines on prostate cancer screening in the U.S.
“The new ACP guidance statement on PSA screening acknowledges the limited potential benefits and significant harms of screening for prostate cancer,” says Michael J. Barry, president of the Informed Medical Decisions Foundation. “The recommendation emphasizes the importance of considering the preferences of informed patients in deciding about screening, and that clinicians should not screen for prostate cancer in patients who do not express a clear preference for screening.”
The authors of the guidance statement recommend that men between the age of 50 and 69 years should be fully informed of the benefits and harms of screening, and the decision to have a PSA test should be based on the patient’s overall health, life expectancy, risk for prostate cancer and preferences. The guidelines advise that “the harms of screening for prostate cancer outweigh the benefits in average-risk men younger than 50 years, men older than 69 years, or men who have a life expectancy less than 10 to 15 years.” However, the decision to undergo a PSA test is extremely preference-sensitive and some men may place more value on the limited potential benefits and less value on the harms associated with the test.
To this end, a shared decision making approach is appropriate for decisions about prostate cancer screening due to the preference-sensitive nature of the decision. We believe it is imperative that patient preferences be incorporated in the decision-making process and applaud the ACP for supporting a shared decision making approach for decisions about prostate cancer screening. By having an informed conversation about a diagnostic tool and disease that is often poorly understood, men can feel confident that they’ve made the decision that’s right for them.
If you are interested in learning more about prostate cancer screening, we recommend reading this New England Journal of Medicine Perspectives piece co-authored by Michael and Dr. Mary F. McNaughton-Collins, Foundation medical director.