U.S. panel concludes that there is “at least moderate certainty” that the harms outweigh the benefits

Updating its recommendations, a federal government panel now advises against screening for prostate cancer in men aged 75 years and older.

The U.S. Preventive Services Task Force (USPSTF) determined that the benefits of prostate cancer screening and treatment would range from small to none for men with an average life expectancy of 10 years or fewer. “Weighing this magnitude of benefit against the moderate-to-substantial psychological and physical harms associated with prostate cancer screening and treatment, the USPSTF concluded that there is at least moderate certainty that the harms of screening for prostate cancer in men aged 75 years and older outweigh the benefits,” the task force wrote in Annals of Internal Medicine (2008;149:185-191).

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For men younger than 75 years, the task force concluded that the “benefits of screening for prostate cancer are uncertain and the balance of benefits and harms cannot be determined.”

In its report, the task force ex-plained that PSA screening presumes that most asymptomatic prostate cancer cases ultimately become symptomatic cases that lead to poor health outcomes. “However, the natural history of PSA-detected, non-palpable, localized prostate cancer is poorly described. No prospective studies have followed a population-based cohort of patients with screening-detected cancer who have had no intervention in order to determine health outcomes from natural progression of the disease.”

The task force also offered suggestions for practice: “Given the uncertainties and controversy surrounding prostate cancer screening in men younger than 75 years, a clinician should not order the PSA test without first discussing with the patient the potential but uncertain benefits and the known harms of prostate cancer screening and treatment.”

The recommendation to avoid screening of men aged 75 and older is not in line with the policy of the American Urological Association (AUA), which says that both PSA testing and digital rectal examination should be offered annually beginning at age 50 to men who have a life expectancy of at least 10 years. Men at high risk, such as African Americans and those with a family history of prostate cancer, should consider testing at an earlier age.