Public recommendations on prostate cancer screening from US cancer centers often do not align with national clinical practice guidelines, investigators report.
The US Preventive Services Task Force, American Cancer Society, and American Urological Association recommend that men at average risk for prostate cancer make shared decisions with their physicians on whether to start PSA testing at age 50 or 55 years and discontinue screening at age 70 years or with fewer than 10 years of life expectancy.
In a survey of 607 US cancer centers, 451 (74%) recommended that men discuss screening with health care professionals in accordance with national guidelines that recommend shared decision-making. But age requirements varied, Jennifer L. Marti, MD, of New York-Presbyterian/Weill Cornell Medicine, New York, New York, and colleagues reported in JAMA Internal Medicine. A third of centers recommended starting discussion at age 50 years and 17% at age 55 years.
A quarter of centers recommended universal screening contrary to national guidelines. A total of 22 centers (4%) recommended universal screening starting before age 50 years, 114 (19%) at age 50 years, and 16 (3%) at age 55 years. Three-fourths of centers did not specify an age at which to stop screening.
Centers designated by the National Cancer Institute were significantly more likely to recommend universal screening without shared decision-making (46% vs 24%), the investigators reported.
Dr Marti’s team found that only 38% of centers discussed potential harms of screening on their websites, and only 19% detailed specific risks. Prostate cancer screening is associated with risks from biopsies, overdiagnosis, and overtreatment, including risks to urinary, sexual, and bowel function.
“A limitation of this study is that the public recommendations of cancer centers may not reflect their clinical practices,” the authors wrote. “Nevertheless, the divergence between these recommendations and national society guidelines highlights the need to encourage shared decision-making for men considering screening.”
Koh ES, Lee AYJ, Ehdaie B, et al. Comparison of US cancer center recommendations for prostate cancer screening with evidence-based guideline. JAMA Intern Med. Published online March 7, 2022. doi:10.1001/jamainternmed.2022.0091