The US Preventive Services Task Force has recently updated its guidelines for screening men for prostate cancer using the prostate-specific antigen (PSA) lab test. Although the guidelines are a little muddier than they were the last time they were changed (in 2012), at least now there is consensus among other physician associations.

The current guidelines go like this: if you are a man older than 70 or younger than 55, the advice is don’t get screened. If you are 55-69 years old, talk with your doctor about the plusses and minuses of screening.

Luckily, both the American Cancer Society and the American Urological Association are mostly in agreement with these recommendations (there are slight differences in when men are recommended to talk with their doctor about PSA testing).

For men older than 70 and younger than 55, the Task Force has concluded that the risks outweigh the potential benefits. There are too many false positives, which lead to too many procedures that can cause real problems, including urinary incontinence and sexual dysfunction.

For those in the 55-69 age bracket, the Task Force felt the risks and benefits were such that it is worthwhile for each man to make the decision with his doctor.

There is a handy graphic [here](https://www.documentcloud.org/documents/3549521-Prostate-screening-understanding-risks-and.html) that shows this demographic, and in particular what happens when 1000 of these men are tested. 240 of those 1000 get a positive result, which leads to a biopsy. The biopsy confirms only 100 have cancer. Of those, 20%-50% of them have cancer that never grows, spreads or harms them.

Of those 100, 80 will choose surgery or radiation. These procedures come with serious possible complications discussed above.

Of those, only 3 will have avoided the cancer spreading, and 1 or 2 of those will have avoided a death from prostate cancer.

The rest either have cancer that never grows, spreads or harms them.

So men in this age bracket are doing some (hopefully) well-informed gambling. Do you want to be screened, knowing that it’s much more likely that it will result in urinary incontinence or sexual impotence (about 6%) instead of preventing death (.1%-.2%)?

For medical negligence attorneys, these new guidelines make it very difficult, absent extenuating circumstances, to argue that a client with metastatic prostate cancer should have been screened. The doctor can easily point to these recommendations as indications that it is not the standard of care to screen such patients.