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USPSTF Update: Screening for Prostate Cancer

JAMA; ePub 2017 Apr 11; Bibbins-Domingo, et al

Publish date:

The US Preventive Services Task Force (USPSTF) has issued a draft recommendation statement on routine screening for prostate cancer, asserting that screening in men aged 55 to 69 years must be individualized. The draft statement includes the following:

  • The USPSTF recommends that clinicians inform men aged 55 to 69 years about the potential benefits and harms of prostate-specific antigen (PSA)–based screening for prostate cancer.
  • The decision about whether to be screened for prostate cancer should be an individual one.
  • The USPSTF recommends individualized decision-making about screening for prostate cancer after discussion with a clinician, so that each man has an opportunity to understand the potential benefits and harms of screening and to incorporate his values and preferences into his decision.
  • The USPSTF recommends against PSA-based screening for prostate cancer in men aged 70 years and older.

Citation:

Bibbins-Domingo K, Grossman DC, Curry SJ. The US Preventive Services Task Force 2017 draft recommendation statement on screening for prostate cancer. An invitation to review and comment. [Published online April 11, 2017.]. JAMA. doi:10.1001/jama.2017.4413.

Commentary:

The Centers for Disease Control and Prevention estimate that more than 2.5 million American men were diagnosed and living with prostate cancer in 2013. There were over 25,000 deaths from prostate cancer, with most of the deaths occurring in men over age 75.1 No commentary sufficiently summarizes the challenges and frustrations felt by clinicians and patients regarding PSA screening decisions, and, in the last 15 years the guidelines about screening have changed regularly. The fundamental problem with prostate cancer screening is that screening does not distinguish between prostate cancers that will cause harm and those that will not. In autopsy studies of men who died of other causes, more than 20% of men aged 50 to 59 years and more than one third of men aged 70 to 79 years were found to have prostate cancer.2 Screening may prevent 1-2 deaths and 3 cases of metastatic prostate cancer per 1,000 men screened over 13 years.3 It is a confusing area, and judging from the C recommendation, the sense of disclarity of evidence is shared by clinicians and experts alike. —Neil Skolnik, MD

  1. National Cancer Institute. Cancer stat facts: Prostate cancer. https://seer.cancer.gov/statfacts/html/prost.html. Accessed March 2, 2017. 

  2. Jahn JL, Giovannucci EL, Stampfer MJ. The high prevalence of undiagnosed prostate cancer at autopsy: Implications for epidemiology and treatment of prostate cancer in the prostate-specific antigen-era. Int J Cancer. 2015;137(12):2795-802. doi:10.1002/ijc.29408.
  3. Fenton JJ, Weyrich MS, Durbin S, Liu Y, Bang H, Melnikow J. Prostate-specific antigen–based screening for prostate cancer: A systematic evidence review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 154. AHRQ Publication No. 17-05229-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2017. 


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