New England Journal of Medicine weighs in with views on PSA testing

In four articles in the respected medical journal, doctors assess the recent change in guidelines on screening for prostate cancer in men.

New England Journal of Medicine: Prostate-Cancer Screening -; What the U.S. Preventive Services Task Force Left Out
Forty years after prostate-specific antigen (PSA) was identified and nearly 20 years after it became available for prostate-cancer screening, the U.S. Preventive Services Task Force (USPSTF) recently recommended against PSA-based screening. ... For two decades, primary care physicians have been expected to present a flawed screening test to patients, cloaking the flaws in an elaborate ritual of informed decision making. In turn, men have been expected to make sense of a confusing mix of hypothetical outcomes. Although the USPSTF recommendation is unlikely to end the PSA controversy, a document finally exists that should provide guidance to clinicians and policymakers (Dr. Allan S. Brett and Richard J. Ablin, 10/26). 

New England Journal of Medicine: One Man at a Time -; Resolving the PSA Controversy 
Watchful waiting and active surveillance may help prevent the conversion of overdiagnosis to overtreatment, mitigating the harms of screening that are so accurately portrayed by the task force. ... we primary care clinicians must ensure there is no more routine, indiscriminate PSA screening -; and no washing our hands of responsibility once the patient is referred to a specialist for prostate-cancer treatment. We owe it to our patients to provide them with the kind of guidance about this screening test that they need and deserve (Drs. Mary F. McNaughton-Collins and Michael J. Barry, 10/26).

New England Journal of Medicine: Stratifying Risk -; The U.S. Preventive Services Task Force and Prostate-Cancer Screening 
This recommendation contradicts the view that PSA-based screening saves lives by reducing the risk of death from prostate cancer. ... PSA screening should not be dismissed as uniformly non-beneficial. Rather, decisions about screening should be made on an individual basis, by an informed patient and his clinician, after weighing that patient's particular risk factors (Dr. Fritz H. Schroder, 10/26).

New England Journal of Medicine: Screening for Prostate Cancer 
A 50-year-old, non-Hispanic white man comes for a new-patient appointment and wants to discuss prostate-cancer screening. He has no family history of prostate cancer and says that he does not have any lower urinary tract symptoms. What would you advise? ... Decisions about prostate-cancer screening should be based on the preferences of an informed patient. The man in the vignette should be engaged in a shared decision-making process that elicits his values and preferences for the potential consequences of testing (Dr. Richard M. Hoffman, 10/26).