U.S. Preventive Services Task Force Makes Recommendations on Prostate Cancer Screening

Men between the ages of 55 and 69 should “make an individual decision” about PSA testing for prostate cancer, according to new recommendations from the U.S. Preventive Services Task Force (USPSTF).

Such decisions should be made after discussing the potential benefits and harms of screening with a doctor, the panel of experts said, adding that men age 70 and over should not be regularly screened, as the “potential benefits do not outweigh the harms.”

The USPSTF is a volunteer group of specialists in a wide range of medical areas, including internal medicine, family medicine, pediatrics, behavioral health, and nursing. The members review scientific evidence to make recommendations on preventive practices, like getting screened for diseases, following healthy habits, and taking certain medications.

These latest recommendations apply to all adult men without prostate cancer symptoms or a prior diagnosis of prostate cancer. They also apply to men who are at increased risk for the disease, including African-American men and men with a family history of prostate cancer.

PSA stands for prostate-specific antigen, a type of protein. Blood tests that measure PSA levels are routine for prostate cancer screening. The problem is that while high PSA levels can be a sign of prostate cancer, they can also be caused by other health conditions, like an enlarged prostate (benign prostatic hyperplasia or BPH) or inflammation of the prostate (prostatitis). Also, some men receive false-positive results.

Elevated PSA results can lead to further blood tests, biopsies, and the start of prostate cancer treatment. And while men with prostate cancer may want to be treated right away, that path isn’t always the best one, experts say.

Treatment for prostate cancer can include radiation, chemotherapy, and surgery, all of which can have negative repercussions, like erectile dysfunction and incontinence.

However, some prostate cancers grow slowly, and some men never need treatment. For these men, undergoing treatment may have consequences that can be avoided.

Nowadays, a strategy called active surveillance is often used. This is a “wait and see” approach. Men have regular checkups with their doctor, but treatment doesn’t start unless and until necessary.

“Prostate cancer is one of the most common cancers to affect men and the decision whether to be screened is complex,” said Task Force vice chair Alex H. Krist, MD, MPH in a press statement. “Men should discuss the benefits and harms of screening with their doctor, so they can make the best choice for themselves based on their values and individual circumstances.”

For more information on prostate cancer and screening, please see these links:

Prostate Cancer (overview)

Understanding the Effects of Biopsies and Prostatectomy

Prostate Cancer and Sex: Questions to Consider

Note: In 2013, the American Urological Association (AUA) set forth these guidelines on prostate cancer screening, which were reviewed and validity confirmed in 2015:

• PSA screening is not recommended in men younger than 40 years.
• Routine screening is not recommended for men between the ages of 40 and 54 who are at average risk for prostate cancer.
• Men between the ages of 55 and 69 should undergo “shared decision-making” about PSA screening “based on a man’s values and preferences.”  For men who decide to proceed, screening conducted every two years (or longer, if appropriate) may be preferred over annual screening.
• PSA screening is not recommended in men age 70 or over or in men with a life expectancy of less than 10 to 15 years.

Resources

American Urological Association“Early Detection of Prostate Cancer”
(Published 2013; Reviewed and Validity Confirmed 2015)
http://www.auanet.org/guidelines/early-detection-of-prostate-cancer-(2013-reviewed-and-validity-confirmed-2015)U.S. Preventive Services Task Force

“Frequently Asked Questions”

(May 2018)

https://screeningforprostatecancer.org/frequently-asked-questions/

“Is Prostate Cancer Screening Right for You?”

(May 2018)

https://screeningforprostatecancer.org/wp-content/uploads/2018/05/USPSTF_ProstateCancer_Infographic_FINAL-5-4.pdf

“U.S. Preventive Services Task Force Issues Final Recommendation on Screening for Prostate Cancer”

(News statement. May 8, 2018)

https://screeningforprostatecancer.org/wp-content/uploads/2018/05/Prostate-Cancer-FRS-News-Bulletin_508-FINAL.pdf