Should primary care clinicians recommend prostate-specific antigen–based screening for prostate cancer to men 55 years or older?

In this updated 2018 review, the US Preventive Services Task Force (USPSTF) recommends counseling men, 55 to 69 years, on the risks and potential benefits (see Synopsis) of undergoing periodic prostate-specific antigen (PSA)–based screening for prostate cancer (C recommendation). Clinicians should not screen men who, after adequate informed consent, do not express a preference for screening. The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older (D recommendation). These recommendations are unchanged based on race or family history of prostate cancer. (LOE = 2c)

US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Screening for prostate cancer. US Preventive Services Task Force recommendation statement. JAMA 2018;319(18):1901-1913.  [PMID:29801017]

Practice guideline

Government

Population-based

In 2012, the USPSTF recommended against routine PSA-based screening for prostate cancer (D recommendation). In this updated 2018 version, the task force has taken into account updated data from 1 of 3 major trials that found, after a median follow-up of 13 years, a reduction from 1.07 to 1.28 /1000 in prostate cancer-specific mortality in men 55 to 69 years. This difference in mortality translates to 1 reduced death from prostate cancer over approximately 10 years per 1000 men screened. Two other large trials continue to report no evidence of a reduction in prostate-cancer related mortality with screening and none of the 3 trials report a reduction in all-cause mortality. All 3 trials continue to report significant complications from screening and subsequent treatment for prostate cancer, including anxiety from false-positive results, urinary incontinence, erectile dysfunction, and death from cardiovascular disease, sepsis, and/or venous thrombotic disease. We should soon have available updated shared decision-making tools highlighting the risks and benefits for the average man. These include the expectation of 1 fewer prostate cancer–related death per 1000 men who undergo PSA screening every 1 to 4 years for 10 years matched by 100 to 120 false-positive results, 110 additional prostate cancer diagnoses, 29 more men with erectile dysfunction, 18 more men with urinary incontinence, and 1 additional man dying prematurely of treatment-related complications. The bottom line: One man is saved from dying of prostate cancer in 10 years, one man dies from treatment for benign prostate cancer, and there is a significant amount of erectile dysfunction and urinary incontinence. The task force also found no benefit of screening for prostate cancer in men 70 years and older, and no evidence of additional benefit based on race or family history of prostate cancer. The American Academy of Family Physicians and the Canadian Task Force on Preventive Health care continue to recommend against PSA-based screening for prostate cancer.