Print edition: 
ATLANTA — Months after experts discounted the importance of routine mammograms and Pap smears for many women, the American Cancer Society is warning more explicitly than ever that regular testing for prostate cancer is of questionable value too, and can do men more harm than good.
The cancer society has not recommended routine screening for most men since the mid-1990s, and that is not changing. But the organization is urging doctors to talk frankly with their patients about the risks and limitations of the PSA blood test when offering it.
Two big studies last year suggested prostate cancer screening doesn't necessarily save lives, and any benefits can come at a high price. The widely used PSA test often spots cancers too slow-growing to be deadly. It can yield false-positive readings that result in unnecessary biopsies. And it can lead to treatments that can cause impotence and incontinence.
"We had a revolution" when PSA tests became available and prostate cancer screenings kicked into high gear, said Len Lichtenfeld, the cancer society's deputy chief medical officer. "Now we're having an evolution. We're learning more about what PSA really tells us."
He added: "We don't know that it truly saves lives the way people want it to save lives."
Some doctors and advocates are troubled by the new guidelines.
"Prostate cancer is still something to be respected if not feared, and we still need to be vigilant. I hope primary care docs or insurance companies don't use the 'softening' of the guidelines as an excuse to not do screening at all," said David Roberts, medical director of an Atlanta clinic that caters to businessmen.
Stephen Freedland, an associate professor of urology at Duke University Medical Center, warned that the medical establishment seems to be moving backward on cancer screening.
"We have seen dramatic drops in mortality from breast, prostate and cervical at a time when screening has been increasing, and now we are stepping off the pedal. I don't think that is the right answer," he said.
Men will need to weigh their fear of having a potentially aggressive cancer versus treatment that can cause ugly side effects. Another option if cancer is found is watchful waiting — that is, doing nothing — but that can mean high anxiety.
S. Adam Ramin, a urological oncology specialist at St. John's Health Center in Santa Monica, Calif., said that the ACS guidelines place too much emphasis on whether the tests save lives and not enough on whether they prevent complications from tumors, such as leaking of urine, incontinence, bone pain, anemia and weight loss.
"Although it is true that treatment will not necessarily save a lot of lives, it does prevent complications," he said.
But other experts noted that treatment itself can produce complications such as urinary incontinence and impotence.
Skip Lockwood, president of Zero: The Project to End Prostate Cancer, said that calls to end the digital rectal exam are "kind of nuts.... The whole concept that you would do anything to reduce the amount of information you have does not make sense to me."
The cancer society's new guidance released Wednesday urges doctors to:
* Discuss the pros and cons of testing with patients, offering written information or videos that discuss the likelihood of false test results and the side effects of treatment.
* Stop routinely giving the rectal exam because it has not clearly shown a benefit, though it can remain an option.
* Use past PSA readings to determine how often follow-up tests are needed and to guide conversations about treatment.
Prostate cancer is the most common cancer in men after skin cancer, affecting 192,000 men each year and killing 27,000. And while all the parties may not totally agree on how and how often PSA screening should be used, they are in unanimous agreement on one point. As Lockwood said, "We need a better test."
