In contrast to its controversial 2012 recommendations against routine PSA-based screening for prostate cancer (PCa), the United States Preventive Services Task Force (USPSTF) is now suggesting screening decisions should be made on an individual basis for men aged 55 to 69 years.
It recommends that clinicians discuss the potential benefits and harms of PSA screening with these men for shared decision-making. PSA screening may reduce the number of deaths, but it may also lead to false-positive results, unnecessary biopsies, overdiagnoses, and treatment complications, such as incontinence and erectile dysfunction.
The USPSTF graded the draft recommendation “C,” which means it considers the net benefit of PSA testing small. The upgrading from the “D” rating in 2012 is based partly on recent scientific evidence that increased the USPSTF’s certainty about reduced chances of PCa metastases and deaths.
Responding to the draft recommendation, Richard K. Babayan, MD, president of the American Urological Association (AUA) stated: “The draft recommendations released today are thoughtful and reasonable, and are in direct alignment with the AUA’s clinical practice guideline and guidelines from most other major physician groups – including the American Cancer Society, the American College of Physicians, the American Society of Clinical Oncology and the National Comprehensive Cancer Network, all of which advocate for shared decision making.”
In a grade D recommendation, the USPSTF continued to discourage PSA screening in men aged 70 and older. The AUA believes that select elderly men in good health may benefit from screening.
The USPSTF acknowledged that black men and men with a family history of PCa have higher risks of developing and dying from the disease and urged these men to discuss their individual risks and preferences with their doctors. Screening may benefit men whose father, brother, or son was diagnosed with advanced PCa, developed metastatic disease, or died from PCa, according to the USPSTF. Having multiple first-degree relatives with PCa has been associated with an earlier age of disease onset.
The USPTF issued the draft recommendations in April 2017 to solicit public comment. It will develop a final recommendation statement after consideration of the feedback.
2. AUA Responds to USPSTF Draft Recommendations on Screening for Prostate Cancer. [news release]. American Urological Association; April 11, 2017.