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Medical panel: Men should be told prostate test has limits

The American Cancer Society is urging doctors to make it clearer to men that the test used to screen for prostate cancer has limits and may lead to unnecessary treatments that do more harm than good.

The cancer society has not recommended routine screening for most men since the mid-1990s, and that is not changing. Its new advice goes further to warn of the limitations of the PSA blood test that millions of American men get now. It also says digital rectal exams should be an option rather than part of a standard screening.

The new advice is the latest pushback from routine screening to hunt for early cancers. Last year, a government task force said most women don't need mammograms in their 40s, and a doctors' group said most women in their 20s don't need annual Pap tests.

American men have long been urged to have prostate cancer screenings, but over time studies have suggested that most cancers found are so slow-growing that most men could have avoided treatment. The treatments can lead to incontinence or impotence.

The Atlanta-based cancer society is perhaps the most influential group in giving screening advice.

Prostate cancer is the most common nonskin cancer in American men. An estimated 192,000 new cases and 27,000 deaths from it occurred last year in the United States.

But it is a slow-growing cancer in many cases and, depending on a man's age, he may be more likely to die of something else. Major studies have suggested routine screening doesn't save lives and often leads to worry and unnecessary treatment.

The new cancer society recommendations could be "game changers" in two respects, said Dr. John Davis, a urologist who directs prostate cancer screening programs for the University of Texas M.D. Anderson Cancer Center in Houston.

First, they could change how routine physical exams for many older men are conducted, he said. About 41 percent of men 50 and older get annual prostate cancer screenings. Even though the cancer society doesn't recommend routine PSA tests, many doctors do it without even asking their patients. The new guidelines may spur doctors to talk to their patients earlier about the pros and cons of getting the test in the first place.

Second, the guidelines could have a chilling effect on community prostate screening clinics in which hundreds of men line up for free, quick exams, Davis said.

That was the intent, said Dr. Andrew Wolf, a University of Virginia physician who led the group writing the guidelines.