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Second, the guidelines could have a chilling effect on community screening clinics in which hundreds of men line up and get free, quick exams, Davis said.
That was the intent, said Dr. Andrew Wolf, a University of Virginia physician who led the group that wrote the new guidelines.
"Yes, the guideline was explicitly crafted to put a damper on those community prostate screening activities that do not offer men the opportunity to make an informed decision whether to screen," Wolf said.
Last year, the American Urological Association -- a longtime proponent of regular prostate screening -- backed off its call for annual tests after age 50. The group said men should be offered a baseline test at 40, with follow-ups based on each man's situation.
The group also has stood by the rectal exam as a standard part of screening, saying it can find cancer that the blood test does not.
The cancer society last issued guidelines in 2001, which said merely that doctors should offer screening and discuss the risks and benefits. The new guidelines back away even more, dropping the sentence that doctors should offer prostate screening.
Instead, the society said that some evidence indicates periodic screening can save lives but that there is uncertainty about the value of finding prostate cancer early. Screening should not take place unless the patient is fully informed of the trade-offs, the society said.
Men at average risk should get detailed information around age 50, the society said. Men at higher risk, including blacks and men with a father or brother who had prostate cancer before age 65, should get the information beginning at 45. Men with more than one close relative with prostate cancer before 65 should get such information at 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. Annual tests are recommended for 2.5 or higher, and a 4 suggests consideration of a biopsy.
Early prostate cancer has no symptoms. Advanced disease may interfere with urination or cause blood in the urine. Many men with slow-growing cancers have been successfully treated after symptoms appear.
There are few good treatments for very advanced cases, though researchers reported Wednesday that an experimental drug extended survival by 10 weeks. They were hopeful that the drug, cabazitaxel, might be more effective in stopping earlier cancers.
The society's new guidelines rankle 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. 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.
On the Net:
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