USPSTF Recommends Against PSA-Based Screening for Prostate Cancer

05/08/18

The United States Preventive Services Task Force (USPSTF) released a statement that prostate-specific antigen (PSA)-based screening for prostate cancer should be avoided in men aged 70 years and older.

The recommendation statement was published in JAMA (online May 8, 2018; doi:10.1001/jama.2018.3710).

The USPSTF updated their 2012 recommendations on PSA-based screening for prostate cancer by reviewing the most up-to-date evidence on the benefits and harms of such screening and subsequent treatment of screen-detected prostate cancer.

Adequate evidence from randomized clinical trials shows that for men aged 55 to 69 years, the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one and should include discussion of the potential benefits and harms of screening with their clinician. While screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men, many men will experience potential harms of screening, including false-positive results that require additional testing and prostate biopsy; overdiagnosis and overtreatment; and treatment complications (ie, incontinence, erectile dysfunction).

The recommendation adds that “In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs.”

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In the concluding recommendations, the USPSTF suggest that clinicians should not screen men who do not express a preference for screening (C recommendation) and men aged 70 years and older should not undergo PSA-based screening for prostate cancer (D recommendation).—Zachary Bessette