Journal article
Screening for Prostate Cancer US Preventive Services Task Force Recommendation Statement
JAMA : the journal of the American Medical Association, Vol.319(18), pp.1901-1913
05/08/2018
DOI: 10.1001/jama.2018.3710
PMID: 29801017
Abstract
IMPORTANCE In the United States, the lifetime risk of being diagnosed with prostate cancer is approximately 13%, and the lifetime risk of dying of prostate cancer is 2.5%. The median age of death from prostate cancer is 80 years. Many men with prostate cancer never experience symptoms and, without screening, would never know they have the disease. African American men and men with a family history of prostate cancer have an increased risk of prostate cancer compared with other men.
OBJECTIVE To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on prostate-specific antigen (PSA)-based screening for prostate cancer.
EVIDENCE REVIEW The USPSTF reviewed the evidence on the benefits and harms of PSA-based screening for prostate cancer and subsequent treatment of screen-detected prostate cancer. The USPSTF also commissioned a review of existing decision analysis models and the over diagnosis rate of PSA-based screening. The reviews also examined the benefits and harms of PSA-based screening in patient subpopulations at higher risk of prostate cancer, including older men, African American men, and men with a family history of prostate cancer.
FINDINGS Adequate evidence from randomized clinical trials shows that PSA-based screening programs in men aged 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened. Screening programs may also prevent approximately 3 cases of metastatic prostate cancer per 1000 men screened. Potential harms of screening include frequent false-positive results and psychological harms. Harms of prostate cancer treatment include erectile dysfunction, urinary incontinence, and bowel symptoms. About 1 in 5 men who undergo radical prostatectomy develop long-term urinary incontinence, and 2 in 3 men will experience long-term erectile dysfunction. Adequate evidence shows that the harms of screening in men older than 70 years are at least moderate and greater than in younger men because of increased risk of false-positive results, diagnostic harms from biopsies, and harms from treatment. The USPSTF concludes with moderate certainty that the net benefit of PSA-based screening for prostate cancer in men aged 55 to 69 years is small for some men. How each man weighs specific benefits and harms will determine whether the overall net benefit is small. The USPSTF concludes with moderate certainty that the potential benefits of PSA-based screening for prostate cancer in men 70 years and older do not outweigh the expected harms.
CONCLUSIONS AND RECOMMENDATION For men aged 55 to 69 years, the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one and should include discussion of the potential benefits and harms of screening with their clinician. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening. (C recommendation) The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older. (D recommendation)
Details
- Title: Subtitle
- Screening for Prostate Cancer US Preventive Services Task Force Recommendation Statement
- Creators
- David C. Grossman - Kaiser Permanente Washington Health Research InstituteSusan J. Curry - University of IowaDouglas K. Owens - Stanford UniversityKirsten Bibbins-Domingo - University of California, San FranciscoAaron B. Caughey - Oregon Health & Science UniversityKarina W. Davidson - Columbia UniversityChyke A. Doubeni - Univ Penn, Philadelphia, PA 19104 USAMark Ebel - Univ Georgia, Athens, GA 30602 USAJohn W. Epling - Virginia TechAlex R. Kemper - Nationwide Children's HospitalAlex H. Krist - Virginia Commonwealth UniversityMartha Kubik - Temple UniversityC. Seth Landefeld - University of Alabama at BirminghamCarol M. Mangione - University of California, Los AngelesMichael Silverstein - Boston UniversityMelissa A. Simon - Northwestern UniversityAlbert L. Siu - Icahn School of Medicine at Mount SinaiChien-Wen Tseng - University of Hawaii SystemUS Preventive Services Task Force
- Resource Type
- Journal article
- Publication Details
- JAMA : the journal of the American Medical Association, Vol.319(18), pp.1901-1913
- Publisher
- Amer Medical Assoc
- DOI
- 10.1001/jama.2018.3710
- PMID
- 29801017
- ISSN
- 0098-7484
- eISSN
- 1538-3598
- Number of pages
- 13
- Grant note
- Agency for Healthcare Research and Quality (AHRQ); United States Department of Health & Human Services; Agency for Healthcare Research & Quality
- Language
- English
- Date published
- 05/08/2018
- Academic Unit
- Health Management and Policy; Community and Behavioral Health
- Record Identifier
- 9984367244702771
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