Prostate Cancer Screening

The U.S. Preventive Services Task Force (USPSTF) has released its draft recommendation statement on prostate cancer screening (available online at uspreventiveservicestaskforce.org). Public comments on the recommendations may be submitted beginning Tuesday, October 11, 2011. The USPSTF has a proposed a “grade D recommendation” that recommends against prostate-specific antigen (PSA)-based screening for prostate cancer. The recommendation applies to men in the U.S. population who do not have symptoms that are highly suspicious for prostate cancer, regardless of age, race, or family history. USPSTF did not evaluate the use of the PSA test as part of the workup of men with symptoms that are highly suspicious for prostate cancer. This recommendation also does not consider the use of the PSA test for surveillance after diagnosis and/or treatment of prostate cancer.

In response, the American Urological Association (AUA) issued a statement saying that the recommendation 'will ultimately do more harm than good.'" The AUA recommends a baseline PSA test for all men in their 40s, annual PSA testing of all males over the age of 50, and annual testing of all men at known risk for prostate cancer staring at a younger age.

A major concern among clinicians is what the USPSTF means by its use of the word “screening (e.g. annual population screening? Screening based on an individual’s risk factors?). Because some men are at higher risk for prostate cancer because of genetics, ethnicity, and family history, and these men need to be accurately informed about the risks and benefits of prostate cancer screening. The USPSTF recommendation is being questioned by the media and many in the cancer community; it’s doubtful that it will be the final recommendation. A more accurate and appropriate recommendation would be to include individualized patient need and risk assessment in the USPSTF prostate cancer screening recommendations.