The controversy over prostate cancer screening guidelines heated up last November, when the U.S. Preventive Services Task Force (USPSTF) advised the elimination of routine prostate-specific antigen (PSA) screening for prostate cancer in healthy men. The morning television news shows immediately discussed the recommendation and cited opposing opinions from urologists, primary care providers, and oncologists.

After a few weeks the discussion died down, at least until May, when the formal guidelines made headlines: No PSA, followed by Not needed, regardless of age. USPSTF said that PSA tests do more harm than good. The conclusions of the panel were based on risks from the procedures that occur as a result of elevated PSA tests, including blood clots, heart attacks, stroke, and possibly death. In addition, impotence and urinary incontinence are common complications of prostate cancer treatment, even for low-grade tumors.

According to the new USPSTF guidelines, PSA screening of healthy men as a means of identifying prostate cancer outweighs the potential to save lives. Elevated PSA readings may not always indicate prostate cancer and can lead to unnecessary prostate biopsies. Even when biopsies reveal signs of prostate cancer cells, the evidence reviewed by the task force showed a large proportion will never cause harm, even if left untreated. In addition, the disease in older men often progresses slowly, so that those who have it frequently die from other causes. This is the recommendation in spite of the fact that more than 25,000 men are expected to die from prostate cancer in 2012.

Once again, the very healthcare providers who are expected to advise patients on what to do to prevent, detect, and treat disease are sending mixed messages to the public. Oncology nurses often find themselves caught in the middle of discussions about what screening should be done. Some people use the controversy as an excuse to avoid all cancer screening, whereas others express concern and frustration over the ever-changing recommendations. Nurses in screening clinics or who provide cancer screening awareness programs must continually shift to address both the controversy and the concern.

No matter what your practice setting, oncology nurses have a responsibility to inform and advise. I recommend using the controversy to start conversations with your patients and your circle of family and friends. You do not have to be an expert in all of the evidence surrounding the screening test. You can use your influence to encourage regular health check-ups and a conversation with healthcare providers about age- and risk-related screening recommendations. I hope the views of the nurses interviewed in this issue offer you food for thought as you initiate those conversations.

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