USPSTF Recommends That PSA Screening Be an Individual Decision

The US Preventive Services Task Force (USPSTF) issued a final recommendation statement on screening for prostate cancer, including that men aged 55 to 69 years should make an individual decision on whether or not to be screened based on conversations with a physician. Men aged 70 years and older, however, should not be screened, because the benefits do not outweigh the harms, according to the recommendation.

“In the United States, the lifetime risk of being diagnosed with prostate cancer is approximately 13%, and the lifetime risk of dying of prostate cancer is 2.5%,” wrote the USPSTF, as led by David C. Grossman, MD, MPH, of the Kaiser Permanente Washington Health Research Institute in Seattle. “Many men with prostate cancer never experience symptoms and, without screening, would never know they have the disease.”

The USPSTF conducted an evidence review to update the 2012 recommendation on prostate-specific antigen (PSA)-based screening for the malignancy. The recommendation statement was published in JAMA, and at www.screeningforprostatecancer.org.

According to the task force’s literature review, randomized trials have shown that PSA-based screening programs in men between the ages of 55 and 69 can prevent approximately 1.3 deaths due to prostate cancer every 13 years per 1,000 men screened. Because of this moderate benefit along with the potential harms, the task force recommends that the decision to undergo screening in this age group should be an individual one.

“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 authors wrote. The median age at death from prostate cancer is 80 years, they pointed out. For men older than 70, the potential harms outweigh the benefits and screening is not recommended.

The available randomized trial evidence also shows that PSA-based screening can prevent approximately 3 cases of metastatic prostate cancer per 1,000 men screened, which should be added into any discussion of benefits and harms. The task force noted that there is inadequate evidence of whether the benefits are different for African-American men aged 55 to 69 years compared with the rest of the population; these men are known to have an increased lifetime risk of prostate cancer death compared with those of other races and ethnicities.

“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,” the task force wrote. “How each man weighs specific benefits and harms will determine whether the overall net benefit is small.”