The US Preventive Services Task Force (USPSTF) has updated its 2012 recommendations on prostate-specific antigen (PSA)–based screening for prostate cancer, according to an article published in JAMA.
This recommendation applies to adult men in the general US population without symptoms or a previous diagnosis of prostate cancer. It also applies to men with an increased risk of death from prostate cancer because of race/ethnicity or family history of prostate cancer.
Screening for prostate cancer in men aged 55 to 69 years offers a small potential benefit of reducing the chance of death. 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. The USPSTF does not recommend screening for prostate cancer unless men express a preference for screening after being informed of and understanding the benefits and risks. The USPSTF also 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.
In 2012, the USPSTF concluded that although there are potential benefits of screening for prostate cancer, these benefits did not outweigh the expected harms enough to recommend routine screening (D recommendation). The change in recommendation grade is based in part on additional evidence that increased the USPSTF’s certainty about the reductions in risk of dying of prostate cancer and risk of metastatic disease.
In an editorial commentary, H. Ballentine Carter, MD, from the Department of Urology and the James Buchanan Brady Urologic Institute at the Johns Hopkins University School of Medicine in Baltimore, stated, “The USPSTF has provided a timely and careful approach to reassessment of the benefits and harms of PSA-based screening for prostate cancer. Patients, together with their physicians, should decide whether prostate cancer screening is right for the patient. In this regard, primary care physicians have an important role in reducing the harms associated with screening and could consider a number of factors in this decision process.”
Neal D. Shore, MD, FACS, president of LUGPA, gave an exclusive statement to the Clinical Advisor, in which he states: “LUGPA has always recommended that patient-physician shared decision making requires thoughtful and clear communication with men of all ages who might be at risk for prostate cancer diagnosis. For those patients with newly diagnosed prostate cancer, LUGPA believes a full discussion of all treatment options, which includes active surveillance and appropriate immediate interventions, is required. LUGPA believes that while the current guidelines do represent a step forward, they simply do not go far enough. LUGPA remains committed to preserving the right of every man to access appropriate screening services after consultation with their healthcare provider.”
- US Preventive Services Task Force. Screening for prostate cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(18):1901-1913. doi:10.1001/jama.2018.3710
- Carter HB. Prostate-specific antigen (PSA) screening for prostate cancer: revisiting the evidence. JAMA. 2018;319(18):1866-1868. doi:10.1001/jama.2018.4914