USPSTF recommends individualized approach to prostate cancer screening

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The USPSTF recommends that prostate cancer screenings should be an individual decision.
The USPSTF recommends that prostate cancer screenings should be an individual decision.

Screening for prostate cancer should be an individual decision for men between 55 to 69 years of age, according to a draft recommendation statement released by the US Preventive Services Task Force (USPSTF).

The USPSTF gave a C grade to the recommendation, noting that clinicians should inform men about the potential benefits and harms of prostate-specific antigen-based screening for prostate cancer. The agency also gave a D grade to the recommendation against screening for prostate cancer in men older than 70 years of age.

“Screening offers a small potential benefit of reducing the chance of dying of prostate cancer,” the USPSTF states in the draft recommendation. “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 impotence.

“The USPSTF recommends individualized decision-making about screening for prostate cancer after a discussion with a clinician, so that each man has an opportunity to understand the potential benefits and harms of screening and to incorporate his values and preferences into his decision.”

The current draft recommendation updates the 2012 USPSTF recommendation, which stated that the potential benefits of prostate cancer screening did not outweigh the expected harms enough to recommend a routine screening (D grade recommendation). Since 2012, the USPSTF concluded that there may be a small net benefit to screening men between 55 and 69 years of age. However, the balance of benefits and harms remains close, and therefore the decision to initiate screening should be an individual choice.

The change in recommendation grade was based on additional evidence that increased the confidence in the benefits in screening. Follow-up from the European Randomized Study of Screening for Prostate Cancer found that prostate-specific antigen-based screenings for prostate cancer prevents 1 to 2 men from dying of prostate cancer for every 1,000 men screened.

The USPSTF notes that current evidence continues to demonstrate the harms of prostate-specific antigen-based screening, including false-positive results, complications from transrectal prostate biopsies, overdiagnosis, and harms of treatment, including urinary incontinence and sexual impotence.

The updated recommendation also identifies African American men and men with a family history as having a higher risk for prostate cancer, and provides additional information to support these men in making an informed decision about screening.

The USPSTF will accept comments from the public for this draft recommendation until May 8, 2017.

References

  1. Bibbins-Domingo K, Grossman DC, Curry SJ. The US Preventive Services Task Force 2017 draft recommendation statement on screening for prostate cancer: An invitation to review and comment. JAMA. 2017 Apr 11. doi:10.1001/jama.2017.4413
  2. Prostate cancer: screening [draft recommendation statement]. US Preventive Services Task Force. Published April 2017. Accessed April 13, 2017.
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