Screening for Prostate Cancer
- Study type
- Clinical guideline
- Study name
- USPSTF Prostate Cancer Screening 2018
- Design
- Clinical guideline recommendation statement based on an evidence review (including a review of randomised trials, decision analysis models and overdiagnosis estimates)
- Source
- JAMA · 2018
In plain words
For men aged 55 to 69, having a PSA test to screen for prostate cancer should be a personal decision made after talking with the doctor about its benefits and harms. For some men the test may slightly lower the risk of dying from prostate cancer, but it can lead to false-positive results, biopsies and unnecessary treatments with side effects such as urinary leakage (incontinence) and erection problems. For men aged 70 and older, PSA screening is not recommended.
Key points
Key guideline recommendations
- C
For men aged 55 to 69 years, the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one and should include a discussion of the potential benefits and harms of screening with their clinician. Clinicians should not screen men who do not express a preference for screening.
- D
The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older.
Study population
Men eligible for prostate cancer screening with the prostate-specific antigen (PSA) test; recommendations are given for the age groups 55 to 69 years and 70 years and older. The reviews also examined higher-risk subgroups, including older men, African American men and men with a family history of prostate cancer.
Endpoints
Benefits and harms of PSA-based screening for prostate cancer and of subsequent treatment of screen-detected cancers, including prostate cancer death, cases of metastatic cancer, false-positive results, psychological harms, overdiagnosis and treatment complications.
Safety and side effects
Potential harms of screening include frequent false-positive results and psychological harms. Harms of prostate cancer treatment include erectile dysfunction, urinary incontinence and bowel symptoms. About 1 in 5 men who undergo radical prostatectomy develop long-term urinary incontinence and 2 in 3 men develop long-term erectile dysfunction. In men over 70 years, the harms of screening are at least moderate and greater than in younger men (because of an increased risk of false-positive results, diagnostic harms from biopsy and harms of treatment). Overdiagnosis and overtreatment are also potential harms.
Clinical significance and place in guidelines
This statement updated the 2012 USPSTF recommendation and, for men aged 55 to 69 years, changed it from a recommendation against screening to an individual, shared decision-making approach (grade C); for men aged 70 years and older the recommendation against screening (grade D) was kept. The current status of these recommendations and their consistency with other bodies' guidelines (and local guidelines) should be checked.
Limitations
The abstract gives only a summary of the findings; details of methodology and quality of evidence are in the full text and its accompanying reviews. Whether the net benefit is small for a given man depends on his individual values regarding the benefits and harms.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.