Updated USPSTF Screening Guidelines for Prostate Cancer
Posted: Wednesday, August 1, 2018
It’s up to you, according to the updated U.S. Preventive Services Task Force (USPSTF) recommendation statement regarding most men aged 55 to 69 years and prostate-specific antigen (PSA)-based prostate cancer screening. For men 70 years and older, the USPSTF concluded that “the potential benefits of PSA-based screening…do not outweigh the expected harms,” wrote corresponding author David C. Grossman, MD, MPH, of Kaiser Permanente Washington Health Research Institute, and colleagues.
Although the U.S. lifetime risk of dying of prostate cancer is 2.5%, “many men with prostate cancer never experience symptoms and, without screening, would never know they have the disease,” the team noted in an article published in The Journal of the American Medical Association.
The USPSTF extensively reviewed evidence to update their 2012 recommendation. It concluded that in the older cohort, screening harms are greater than in the younger cohort “because of an increased risk of false-positive results, diagnostic harms from biopsies, and harms from treatment.”
The younger men should know that PSA-based screening can result in “frequent false-positive results and psychological harms,” noted the authors. Prostate cancer treatment can result in erectile dysfunction, urinary incontinence, and bowel symptoms, especially in men who undergo prostatectomy. Conversely, per 1,000 men screened, screening “may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years…[and] prevent approximately 3 cases of metastatic prostate cancer.”
African American men and men with a family history of prostate cancer—both at higher-than-average risk of developing prostate cancer—should, with their clinicians, take that into consideration when making screening decisions, Dr. Grossman and the USPSTF stated.