Screening for Prostate Cancer: A Recommendation from the U.S. Preventive Services Task Force

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The summary below is from the full reports titled "Screening for Prostate Cancer: Recommendation and Rationale" and "Screening for Prostate Cancer: An Update of the Evidence for the U.S. Preventive Services Task Force." They are in the 3 December 2002 issue of Annals of Internal Medicine (volume 137, pages 915-916 and pages 917-929). The first report was written by the U.S. Preventive Services Task Force; the second report was written by R Harris and KN Lohr.

What is the U.S. Preventive Services Task Force?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

The prostate gland is an organ surrounding the tube that empties urine from the bladder. Its function is to add fluid and nutrients to semen, the fluid that carries sperm. Prostate cancer is the most common type of cancer and the second most common cause of cancer-related death in U.S. men. However, prostate cancer often grows slowly and never causes a problem.

Digital rectal examination (DRE) and prostate-specific antigen (PSA) tests can find prostate cancer early, before symptoms develop. In DRE, a doctor inserts a finger into the patient's rectum to feel the prostate. A PSA test is a blood test. Very high PSA levels occur only with prostate cancer, but the more common intermediate levels also occur with benign prostate disease. Abnormal results on DRE or high PSA levels require prostate biopsy to see whether cancer is actually present. To perform the biopsy, doctors insert a hollow needle to obtain a piece of the prostate gland that can be examined under a microscope.

It is not known whether detection and treatment before symptoms develop are helpful to patients. In most cases, prostate cancer grows very slowly, so most men with early prostate cancer die of something else rather than of prostate cancer itself. Early detection, however, puts men at risk for unnecessary worry and side effects of treatment. Surgery and radiation therapy, common treatments for prostate cancer, can cause impotence and urinary leakage.

How did the USPSTF develop these recommendations?

The USPSTF reviewed published research to measure the benefits and harms of screening for prostate cancer.

What did the authors find?

The USPSTF found good evidence that PSA testing can find early prostate cancer. The evidence suggests that PSA testing correctly identifies more men with prostate cancer than DRE. However, no good-quality evidence shows that finding prostate cancer early means that fewer men die of the disease. Men most likely to benefit if screening is effective are those who are 50 to 70 years of age and those who are older than 45 years of age and at higher risk for prostate cancer because they are African American or because they have a father or brother with prostate cancer.

What does the USPSTF suggest that patients do?

The USPSTF does not recommend for or against routine screening for prostate cancer using DRE or PSA testing. Men who are interested in screening for prostate cancer should discuss it with their doctors and, most important, should not be screened without first understanding the potential benefits and harms of early treatment.

What are the cautions related to these recommendations?

As better information about the positive and negative effects of early detection and treatment of prostate cancer becomes available, the USPSTF may revisit this issue.