USPSTF Recommendations on PSA-Based Screening for Prostate Cancer
As reported in JAMA, the US Preventive Services Task Force (USPSTF) has issued updated recommendations on prostate-specific antigen (PSA)-based screening for prostate cancer.
To inform the recommendations, the USPSTF reviewed evidence on benefits and harms of PSA-based screening and treatment of screen-detected prostate cancer and commissioned a review of decision analysis models and overdiagnosis rate with PSA-based screening. The reviews also assessed benefits and harms of screening in patient subpopulations at higher risk of prostate cancer, including older men, African American men, and men with family history of prostate cancer.
- Adequate evidence from randomized clinical trials shows that PSA-based screening programs in men aged 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1,000 men screened.
- Screening programs may also prevent approximately 3 cases of metastatic prostate cancer per 1,000 men screened.
- Potential harms of screening include frequent false-positive results and psychological harms.
- Harms of prostate cancer treatment include erectile dysfunction, urinary incontinence, and bowel symptoms. About 1 in 5 men who undergo radical prostatectomy develop long-term urinary incontinence and 2 in 3 men experience long-term erectile dysfunction.
- Adequate evidence shows that the harms of screening in men aged > 70 years are at least moderate and greater than in younger men due to increased risk of false-positive results, diagnostic harms from biopsies, and harms from treatment.
- The USPSTF concludes with moderate certainty that the net benefit of PSA-based screening for prostate cancer in men aged 55 to 69 years is small for some men. How each man weighs specific benefits and harms will determine whether the overall net benefit is small.
- The USPSTF concludes with moderate certainty that the potential benefits of PSA-based screening for prostate cancer in men 70 years and older do not outweigh the expected harms.
Conclusions and Recommendations
- For men aged 55 to 69 years, the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one and should include discussion of the potential benefits and harms of screening with their clinician.
- Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including: false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction.
- In determining whether screening is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history; race/ethnicity; comorbid medical conditions; patient values regarding the benefits and harms of screening and treatment-specific outcomes; and other health needs.
Recommendation: Clinicians should not screen men who do not express a preference for screening. (C recommendation: There is at least moderate certainty that the net benefit is small.)
Recommendation: The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older. (D recommendation: There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits).
David C. Grossman, MD, MPH, of Kaiser Permanente Washington Health Research Institute, is the corresponding author for the JAMA article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.