The U.S. Preventive Services Task Force (USPSTF) has been releasing new and updated guidelines periodically. It grades each of its recommendations according to a system described on the USPSTF website.
In 2002, the USPSTF concluded that evidence was insufficient to recommend any type of screening for prostate cancer (JW Jan 10 2003). The task force recently updated the guidelines after reevaluating data on the prostate-specific antigen (PSA) test — the most sensitive screening test. They concluded that the evidence remains insufficient to assess the balance of benefits and harms of screening men who are younger than 75. Recommendation: I (The USPSTF concludes that current evidence is insufficient.)
However, the USPSTF found sufficient evidence to indicate that treating prostate cancer that is detected by screening older men (
75) yields small or no benefit. The task force recommends against PSA screening for prostate cancer in older men. Recommendation: D (The USPSTF recommends against the service.) The harms of screening for both younger and older men include discomfort during prostate biopsy and possible adverse consequences of treating prostate cancer, such as erectile dysfunction, incontinence, and death.A systematic review identified no good-quality randomized trials of prostate cancer screening. The authors observed that the natural history of PSA-detected prostate cancer is not well understood and that prospective studies have identified psychological distress associated with false-positive tests.
Comment: Most major medical organizations recommend discussing the potential benefits and the known harms of prostate cancer screening with patients. Despite this recommendation and USPSTF evidence reviews and recommendations, many physicians believe that prostate cancer screening is beneficial, and PSA testing has increased dramatically. Two large ongoing trials of PSA screening in Europe and in the U.S. (JW Sep 27 2007) hold promise for settling this controversy.
— Richard Saitz, MD, MPH, FACP, FASAM
Published in Journal Watch General Medicine August 26, 2008