New prostate cancer screening recommendations from the American College of Physicians (ACP) advise most men to avoid the prostate specific antigen (PSA) test, which carries substantial risks.

"Before PSA testing, doctors and patients should discuss the potential benefits and harms of screening and the patient's individual risk of prostate cancer, general health, and preferences for testing and evaluation," said Dr. David L. Bronson, President of the ACP. "Only men between the ages of 50 and 69 who express a clear preference for screening should have the PSA test. For most of these men, the harms will outweigh the benefits."

The statement, released in the April 9 issue of Annals of Internal Medicine, follows the U.S. Preventive Services Task Force's 2012 controversial recommendations against PSA test prostate cancer screening for men who have no symptoms of the illness.

The prostate specific antigen (PSA) test measures the amount of PSA circulating in the blood. PSA is a protein produced by the prostate gland, and men with higher levels may be more likely to have prostate cancer.

However, recent research has found the PSA test to be an unreliable indicator of prostate cancer. It may result in a false positive, since PSA levels can be high with an enlarged prostate or when taking certain medications, or a false negative, since PSA levels may be low even though cancer is present.

False positives usually lead to biopsy, an invasive procedure in which needles are inserted into the prostate under local anesthesia in order to remove tissue for analysis. The U.S. Preventive Services Task Force reports that as many as one-third of men undergoing biopsy experience fever, infection, bleeding, urinary problems, or pain, and that there is a small risk of hospitalization from these complications.

In addition, most prostate cancers are benign and develop too slowly to merit treatment.

"A small number of prostate cancers are serious and can cause death," said Dr. Amir Qaseem, Director of Clinical Policy at the ACP, in a statement. "However, the vast majority of prostate cancers are slow-growing and do not cause death."

Qaseem went to say that the potential benefits of prostate cancer screening are outweighed by the significant risk of harms from aggressive prostate cancer treatments, like surgery or radiation, which can result in incontinence, erectile dysfunction, and other undesirable side effects.

In its new recommendations, the ACP advises against PSA testing in men who are younger than 50, older than 69, or have a life expectancy of less than 10 to 15 years, since they are a low-risk group for prostate cancer and unlikely to benefit. Doctors should thoroughly discuss the significant risks of prostate cancer screening with men between 50 and 69 who are at high risk for prostate cancer, and let them decide whether or not to undergo the procedure. The full recommendations include talking points for doctors and patients.

The New York Times announced last month that more sophisticated, specific, and reliable new prostate cancer tests are soon to arrive to market, and that researchers hope they can displace PSA blood tests and digital rectal exams as the main methods of screening.

"We need a new refined testing approach for this disease that will yield better, more accurate diagnoses," said Bronson to Reuters Health.

According to the American Cancer Society, prostate cancer is the second most common cancer in American men - one in six men will be diagnosed with prostate cancer during his lifetime. Over 200,000 new cases will be diagnosed in 2013, and 29,720 men are projected to die of the illness this year.

You can read the full recommendations at the Annals of Internal Medicine website.