WASHINGTON – The blood test millions of men undergo each year to screen for prostate cancer leads to so much unnecessary anxiety, surgery and complications that doctors should stop testing elderly men, and it remains unclear whether the test is worthwhile for younger men, a federal task force concluded Monday.

In the first update of its recommendations for prostate cancer screening in five years, the widely respected panel that sets government policy on preventive medicine said that the evidence that the test reduces the cancer's death toll is too uncertain to endorse routine use for men at any age, and the potential harms clearly outweigh any benefits for men age 75 and older.

"The benefit of screening at this time is uncertain, and if there is a benefit, it's likely to be small," said Ned Calonge, who chairs the 16-member U.S. Preventive Services Task Force. "And on the other side, the risks are large and dramatic."

The task force and other groups had concluded previously that it was unclear whether the benefits of the prostate-specific antigen, or PSA, test outweigh the risks. The new review of the scientific literature found no evidence to alter that assessment for younger men, but it found enough new data had emerged to recommend for the first time against screening for older men.

"We felt with sufficient certainty that your risk of being harmed exceeded your potential benefits starting at age 75," Dr. Calonge said.

The recommendations come at a time when doctors are increasingly questioning whether many tests, drugs and procedures are being overused, unnecessarily driving up costs and exposing patients to the risks of unneeded treatment.

"There is this idea that more is always better, and if a test is available we should use it," said Howard Brody, a professor of family medicine at the University of Texas Medical Branch at Galveston. "A lot of time we're doing more harm than good."

The new guidelines published in the Annals of Internal Medicine were praised by officials at several leading medical groups, including the National Cancer Institute and the American Cancer Society. But they drew criticism from others who are convinced routine screening is necessary.

"I think they're really missing the boat," said William Catalona, a professor of urology at Northwestern University. "It's a disservice to patients. A lot of men die from prostate cancer, and there's just an overwhelming amount of evidence that screening saves lives."

The task force said men younger than age 75 should be carefully counseled before getting the test. But other experts objected to setting an age cutoff.

"Men are living a lot longer and healthier these days. I play golf with 84-year-old guys who beat me all the time," said E. David Crawford, a professor of surgery and radiation at the University of Colorado. "You have to individualize treatment."

Rob Stein,

The Washington Post

•The test has significantly increased the number of early-stage diagnoses.

But it remains unclear whether that translates into a reduction in the death rate from prostate cancer. The disease can grow so slowly that many men die from something else without ever knowing they had it.

•It is not clear precisely what PSA level signals the presence of cancer. Many men experience false alarms that lead to unnecessary biopsies to make a definitive diagnosis, which can be painful and in rare cases can cause serious complications.

•Even when the test picks up a real cancer, doctors are uncertain what, if anything, men should do about it. Many men simply are monitored closely to see if the tumor grows or spreads. But others undergo surgery, radiation and hormone treatments, which often leave them incontinent, impotent and suffering from other complications.

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