USPSTF Recommends Against PSA-based Prostate Cancer Screening

In its newest Statement published yesterday in the Annals of Internal Medicine, the U.S. Preventive Services Task Force (USPSTF) recommends against PSA-based screening for prostate cancer. Read the full paper (free) here.

Prostate Cancer: Facts

• Most commonly diagnosed non-skin cancer in men in USA, estimated lifetime risk 15.9%
• Most cases have good prognosis even without treatment
• Lifetime risk of dying of prostate cancer 2.8%

Screening with PSA

• PSA-based screening programs detect many cases of asymptomatic prostate cancer but evidence suggests that many of them will not progress or will progress slowly that it would have remained asymptomatic for the lifetime
• "Overdiagnosis" of prostate cancer based on PSA is between 17-50% 
• Screening resulted in none or minimal reduction in prostate cancer mortality (0 to 1 prostate cancer deaths avoided per 1000 men screened)
• "False positivity" near 80% (cutoffs value 2.5-4 ug/L)

Recommendation

• Applies to men in general US population. Although older age is the strongest risk factor for development of prostate cancer, neither screening nor treatment trials show benefit in men older than 70 years
• Decision to initiate or continue PSA screening should be understood by patients about possible benefits and harms of screening

Recommendations of Others

• The American Urological Association, the American Academy of Family Physicians and the American College of Physicians: currently updating their guideline
• The American Cancer Society: men at average risk beginning at age 50 years and black men or men with a family history of prostate cancer beginning at age 45 years

Reference:

Annals of Internal Medicine May 21, 2012  LINK