The decision to undergo periodic prostate-specific antigen (PSA)-based screening for prostate cancer should be an individual one for men ages 55 to 69 years, made after a discussion of screening's benefits and harms with a clinician, according to an updated recommendation from the U.S. Preventive Services Task Force (USPSTF).
Patients and clinicians should consider family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs, according to the USPSTF's Grade C recommendation. Clinicians should not screen men who do not express a preference for screening, and the Task Force recommends against PSA-based screening for prostate cancer in men ages 70 years and older (Grade D recommendation).
The recommendation statement and evidence review supporting the update to the 2012 recommendations were published in the May 8 JAMA.
PSA-based screening programs in men ages 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1,000 men screened, according to the statement. In addition, screening programs may prevent approximately three cases of metastatic prostate cancer per 1,000 men screened.
Potential harms of screening include frequent false-positive results and psychological harms, while potential harms of treatment include erectile dysfunction, urinary incontinence, and bowel symptoms, the recommendation statement said. Long-term urinary incontinence will develop in approximately one in five men who receive radical prostatectomy, while two in three men will experience long-term erectile dysfunction, according to the recommendation statement.
Adequate evidence shows that in men older than age 70 years, the harms of screening are at least moderate and greater than in younger men because of increased risk for false-positive results, diagnostic harms from biopsies, and harms from treatment. The Task Force concluded with moderate certainty that the potential benefits of PSA-based screening for prostate cancer in men ages 70 years and older do not outweigh the expected harms.
A related editorial published in the May 8 JAMA Internal Medicine said that active surveillance might not be as promising an option for mitigating the harms of overdiagnosis as the Task Force implies.
“We now better appreciate that prostate cancer screening is associated with benefits and harms at both the population and individual levels,” the editorial stated. “While PSA is an imperfect tumor marker, it is currently the most widely offered and studied prostate cancer screening test. By minimizing the risks of unwanted testing and treatments while supporting uptake of effective treatments, shared decision making for PSA screening may help maximize the net benefits of screening.”