The new guidelines back away even more, dropping the sentence that doctors should offer prostate screening. Instead, the society says some evidence indicates periodic screening can save lives but that there are significant uncertainties about the overall value of finding prostate cancer early. Screening should not take place, the new advice says, unless a patient is fully informed of the trade-offs.
In a nod to the busy workload of doctors, the guidelines recommend videos, brochures and other "patient decision aids."
Men at average risk should get detailed information around age 50, the society recommends. Men at higher risk, including African-Americans and men with a father or brother who had prostate cancer before age 65, should get the information beginning at age 45. Men with more than one close relative with prostate cancer before 65 should get such information at age 40.
For men who want to be screened regularly, the new guidelines recommend every other year if the PSA reading is less than 2.5, a measure of prostate specific antigen per milligram of blood. Annual tests are recommended for 2.5 or higher and a 4 suggests consideration of a biopsy.
The urological association considers the cancer society's advice too simplistic and says it's important to consider any rapid rise in PSA results.
The society's new guidelines rankled Skip Lockwood, president and CEO of Zero -- The Project to End Prostate Cancer, formerly known as the National Prostate Cancer Coalition.
Lockwood's group recommends annual PSA tests for men beginning at 45, and conducts mobile prostate cancer screening programs at state fairs, churches and other sites. The group provides information about the risks and benefits of screening, and connects men to follow-up care if needed, he said.
What bothers him most in the new guidance is "the certainty of its tone," Lockwood said.
"We acknowledge that the PSA test is lacking. I think nobody disagrees on that fact. I think that we all understand that this is not cut and dry -- not an all or nothing situation," he said.
Associated Press Writer Stephanie Nano in New York contributed to this report.
