The United States Preventive Services Task Force (USPSTF) has issued a final recommendation against prostate-specific antigen (PSA)-based screening for prostate cancer for all men, regardless of age. The recommendation, published by Annals of Internal Medicine, updates the group’s 2008 recommendations, in which the Task Force members had concluded that there was no evidence to support PSA screening for men older than 75 years.
The USPSTF based its latest guidance on a review of evidence published since 2008, finding that the harms of PSA testing outweigh the benefits for men of any age. (The task force considers health benefits and harms, but not costs, when developing its recommendations.) As noted in a statement issued by the American College of Physicians, the organization that publishes Annals of Internal Medicine, strong evidence shows that PSA screening is associated with significant harms, such as suffering lifelong urinary incontinence, bowel dysfunction, and erectile dysfunction after undergoing early treatment for PSA-detected prostate cancer, as nearly 90% of men do.
Two major trials of PSA testing in asymptomatic men informed that decision. In one, conducted in the United States, screening did not reduce prostate cancer mortality. In the other study, conducted in seven European countries, approximately one death was prevented for every 1,000 men, aged 55 to 69 years, who were screened, mostly in two countries. Five countries did not find a statistically significant reduction in deaths.
In an accompanying editorial, William J. Catalona, MD, and coauthors charged that the USPSTF underestimated the benefits and overestimated the harms of using PSA-based screening for prostate cancer, and that the recommendation was based on flawed studies with inadequate follow-up time. Catalona is medical director of the Urological Research Foundation in St. Louis, Missouri, and was the developer of the prostate-specific antigen test for prostate cancer screening. ONA