USPSTF Recs on Prostate Cancer Screening: New or Déjà Vu?

Gerald Chodak, MD


July 27, 2018

Hello. I am Dr Gerald Chodak for Medscape. Today's topic is the latest recommendations from the US Preventive Services Task Force regarding screening for prostate cancer. In their previous guideline, they had advised against routine screening because they felt that the harms outweighed the benefits. Now, some updated data allow them to modify those recommendations.[1]

They now state that men should make an informed decision about whether to be screened after being made aware of the risks and benefits. Those risks and benefits [of prostate-specific antigen (PSA) screening] include the following: For every 1000 men who get screened, over the course of about 13 years, 240 will have an abnormal test warranting a prostate biopsy and 100 men will be diagnosed with prostate cancer. Of them, three will avoid developing metastatic disease and one will avoid dying from prostate cancer. There should also be a discussion of the harms associated with the various treatments.

What about high-risk men, such as African Americans or those with a family history of prostate cancer? It is clear that the risk from the disease is greater for them than it is for other men, but it is unclear whether the harms or the benefits of screening are any different. For that reason, men should simply be made aware of their increased risk when they decide what to do.

The challenge going forward, of course, is going to be delivering this information to patients. Should they have a formal consultation by a urologist? That is unlikely to occur. Most PSA testing goes on in the family practice office. The challenge for them will be finding a way to deliver this information quickly and easily. Certainly, a simple tear sheet that contains the important statistical information can be a way to start the conversation and, hopefully, help men decide what is right for them.

What about for men over 70 years? The Task Force did not recommend screening in those men because the harms outweigh the benefits. Nevertheless, there are older men who have a long life expectancy and who may still choose to proceed with screening even though the data are not there to prove whether or not they have a significant benefit. At least they, too, can make an informed decision.

Hopefully this will be the last we have to write about screening for prostate cancer. I look forward to your comments. Thank you.


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