USPSTF 2018 Recommendation on PSA Screening
In 2012, the United States Preventive Services Task Force (USPSTF) recommended against screening for prostate cancer with prostate specific antigen (PSA). This year, USPSTF published an update on PSA based screening for prostate cancer.
Their review of randomized clinical trials revealed that PSA screening of men aged 55 to 69 years prevents approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened. Screening also prevents approximately 3 cases of metastatic cancer per 1000 men screened.
Potential harms of screening include frequent false positive results and psychological harms. Harms of prostate cancer treatment include erectile dysfunction, urinary incontinence, and bowel symptoms. About 1 in 5 men who undergo radical prostatectomy develop long-term urinary incontinence, and 2 in 3 men will experience long-term erectile dysfunction.
After review of the evidence on the benefits and harms, USPSTF concluded with moderate certainty that adequate evidence now exists to conclude that screening offers a small potential benefit of reducing the chance of death from prostate cancer in men between the ages of 55 and 69 years.
The harms of screening men older than 70 years are greater than in younger men because of increased risk of false-positive results, diagnostic harms from biopsies, and harms from treatment. USPSTF recommended against PSA screening for prostate cancer in men 70 years and older.
USPSTF concluded there is still inadequate evidence to assess whether the benefits for African American men and men with a family history of prostate cancer aged 55 to 69 years are different than the benefits for the average-risk population. There is also inadequate evidence to determine if these high risk groups should begin PSA screening before age 55 years.
References
Screening for Prostate Cancer :US Preventive Services Task Force Recommendation Statement, JAMA2018;319:1901-13.
Fenton JJ, et al. Prostate-Specific Antigen-Based Screening for Prostate Cancer: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2018;319:1914-31.
Carter HB. Prostate-Specific Antigen (PSA) Screening for Prostate Cancer: Revisiting the Evidence. JAMA 2018;319:1866-88.
