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Screening for Prostate Cancer with Prostate-Specific Antigen Testing: U.S. Preventive Services Task Force Recommendations
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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 is an organ in men that surrounds the tube that empties urine from the bladder. It adds fluid and nutrients to semen, the fluid that carries sperm. Prostate cancer is the most common nonskin cancer and the second leading cause of cancer death in men.
Measurement of prostate-specific antigen (PSA) in the blood can find prostate cancer before symptoms develop. Abnormal PSA levels require prostate biopsy to see whether cancer is actually present. To perform the biopsy, doctors insert a hollow needle into the prostate to obtain a piece of the prostate gland to examine under a microscope.
It is not known whether treating prostate cancer before symptoms develop helps patients. Most prostate cancer grows very slowly, and many men with prostate cancer die of something else before the prostate cancer causes a problem. 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 problems with sexual function and bowel and bladder incontinence.
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?
Good evidence indicates that PSA testing can find prostate cancer. However, for men younger than 75 years, no good-quality evidence shows that finding prostate cancer by screening rather than waiting until symptoms develop leads to fewer men dying of the disease. For men age 75 years or older, the benefits of finding prostate cancer by screening are small to none.
Good evidence indicates that treatment of prostate cancer found by screening can cause harms, such as sexual dysfunction, bowel and bladder incontinence, and even death. Other harms from screening include pain from prostate biopsy and worry about test results.
What does the USPSTF suggest that patients do?
For men younger than 75 years, the USPSTF does not recommend for or against routine screening for prostate cancer by using PSA testing. Men who are interested in screening for prostate cancer should discuss it with their doctors. Before screening, men should understand the potential benefits and harms of early treatment.
For men age 75 years or older, the USPSTF recommends that doctors and patients do not routinely screen for prostate cancer because the harms are likely to outweigh the benefits.
What are the cautions related to these recommendations?
These recommendations apply to men at average risk for prostate cancer and not to men at high risk, such as those with a father or brother with prostate cancer.
Article and Author Information
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The summary below is from the full reports titled “Screening for Prostate Cancer: U.S. Preventive Services Task Force Recommendation Statement” and “Benefits and Harms of Prostate-Specific Antigen Screening for Prostate Cancer: An Evidence Update for the U.S. Preventive Services Task Force.” They are in the 5 August 2008 issue of Annals of Internal Medicine (volume 149, pages 185-191 and pages 192-199). The first report was written by the U.S. Preventive Services Task Force; the second report was written by K. Lin, R. Lipsitz, T. Miller, and S. Janakiraman.
