USPSTF Updates Prostate Cancer Screening Recommendations

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The new statement emphasizes shared decision-making on screening for men aged 55 to 69 years who are at average risk for prostate cancer.
The new statement emphasizes shared decision-making on screening for men aged 55 to 69 years who are at average risk for prostate cancer.

The US Preventive Services Task Force (USPSTF) has updated its recommendations on prostate cancer screening (PCa) after reviewing evidence published since the issuance of its 2012 statement.

In a paper published in the Journal of the American Medical Association, the USPSTF concluded that men aged 55 to 69 years should decide whether to undergo periodic PSA screening after a discussion of the potential benefits and harms with their clinician. According to USPSTF, there is “moderate certainty” of a “small” benefit of reducing death with screening of men in this age group (grade C recommendation). Such screening may prevent 1.3 PCa deaths per 1000 men screened over 13 years. Screening may also prevent 3 cases of metastatic PCa per 1000 men screened. Men are free to decide against screening, if they desire.

In addition, the USPSTF newly recommends against PSA screening for men older than 70 (grade D recommendation) because the harms generally outweigh the benefits.

In its 2012 statement, the USPSTF discouraged PSA screening for men of all ages, regardless of family history or race. The recommendation was based on grade D evidence suggesting that the harms of testing outweigh the benefits.

“The USPSTF has provided a timely and careful approach to reassessment of the benefits and harms of PSA-based screening for prostate cancer,” H. Ballantine Carter, MD, of Johns Hopkins Medicine, wrote in an accompanying editorial. “Patients, together with their physicians, should decide whether prostate cancer screening is right for the patient.”

The task force was unable to make any specific recommendations for black men and men with a family history of PCa in this latest update and encouraged further research on these populations. “The ratio of benefit to harm could be higher compared with the average-risk man, and these men may benefit from PSA testing that begins before age 55 years,” Dr Carter noted.

The potential harms of screening include false-positive results, overdiagnosis, and overtreatment. According to the USPSTF, “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.”

The recommendations supporting screening of men 55 to 69 align with the American Urological Association's (AUA) clinical practice guideline and guidelines from most other major physician groups. However, the AUA supports screening of healthier men over age 70.

References

US Preventive Services Task Force. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;319(18):1901-1913. doi:10.1001/jama.2018.3710

Ballentine Carter H. Prostate-specific antigen (PSA) screening for prostate cancer revisiting the evidence. JAMA 2018 May 8;319(18) [Published online May 8, 2018]

Fenton JJ, Weyrich MS, Durbin S, 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(18):1914-1931. doi:10.1001/jama.2018.3712

AUA Responds to USPSTF Final Recommendations on Screening for Prostate Cancer. American Urological Association; May 8, 2018. [news release]

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