This article is more than 5 years old. Information may no longer be current.
Task force recommends against automatic PSA screening
The US Preventive Services Task Force today released a final recommendation against prostate cancer screening for all healthy men, regardless of age.
Members of the task force — who issued draft recommendations in October and kept them unchanged after a public comment period — concluded that the harms of PSA testing outweigh the benefits. Still, they said the ability to offer screening still rests in the hands of health care providers.
“The USPSTF recognizes that clinical, policy and coverage decisions involve more considerations than evidence alone,” Virginia A. Moyer, MD, MPH, the head of academic general pediatrics and professor of pediatrics at Baylor College of Medicine in Houston, said in a press release. “Clinicians and health care providers should understand the evidence but individualize decision-making to the specific patient or situation.”
The recommendations will be published online Tuesday in the Annals of Internal Medicine.
The task force last published prostate cancer screening recommendations in 2008. At that time, members suggested that evidence did not support PSA testing for men aged older than 75 years, and evidence was insufficient to determine whether screening had value for younger men.
Before crafting the new recommendations, independent experts reviewed evidence published since 2008, including the results of two major trials of PSA testing in symptom-free men.
One trial, conducted in the United States, demonstrated that PSA testing did not reduce prostate cancer mortality. The second trial took place in seven countries in Europe, and researchers in five of the seven countries did not report statistically significant reductions in death.
PSA screening often diagnoses prostate cancer that may not progress during a patient’s lifetime, Otis W. Brawley, MD, MPH, chief medical officer of the American Cancer Society, wrote in an accompanying editorial.
“Many people have a blind faith in early detection of cancer and subsequent aggressive medical intervention whenever cancer is found,” Brawley wrote. “There is little appreciation of the harms that screening and medical interventions can cause.”
Nearly 90% of men with PSA-detected prostate cancer undergo early treatment with surgery, radiation or androgen deprivation therapy, according to the task force. Evidence suggests that up to five in 1,000 men will die within 1 month of prostate cancer surgery, and up to 70 of 1,000 men who survive will experience adverse effects such as erectile dysfunction, urinary incontinence and bowel dysfunction.
Still, the task force — which does not include a urologist or cancer specialists — overestimated the harms of prostate cancer screening and underestimated its benefits, William J. Catalona, MD, medical director of the Urological Research Foundation, wrote in a second accompanying editorial.
The task force based its recommendations largely on flawed studies with inadequate follow-up time, Catalona and colleagues wrote.
The recommendations also ignore younger men and those at high risk for prostate cancer, editorialist Henry Lynch, MD, director of the Hereditary Cancer Center at Creighton University, said in a press release.
“The recommendations of the USPSTF carry considerable weight with Medicare and other third-party insurers,” Lynch said. “My colleagues and I strongly believe that the task force recommendations should not be used as justification by insurers, including Medicare, to deny diagnosis of prostate cancer to the male population risk.”