New USPSTF Recommendations Urge Individualized Prostate Screening

New draft recommendations from the U.S. Preventive Services Task Force (USPSTF) suggesting prostate screening decisions should be made on an individual basis for men aged 55 to 69 years are a step in the right direction, experts say.

The recommendation is in contrast to USPSTF 2012 guidelines which recommended against routine screening in men of all ages.

In the draft recommendation issued Tuesday, USPSTF advises clinicians to discuss the potential benefits and harms of prostate-specific antigen (PSA) screening in men aged 55 to 69, but that ultimately, the decision should be an individual one.

“Based on the science demonstrating the value of prostate screening, it’s not surprising that the USPSTF has proposed revised recommendations,” said Colleen Lawton, MD, vice chair of the Department of Radiation Oncology at the Medical College of Wisconsin, Milwaukee. “We can’t change the impact of the 2012 guidelines, but this draft is a step in the right direction.”

In its proposal, USPSTF maintained its stance against PSA screening for men 70 years of age and older — a recommendation that uses too broad a brush when an individual approach is necessary, Dr. Lawton said.

“Doctors should make the decision about PSA screening based on the 75- or 80-year-old man standing in front of them,” said Dr. Lawton, who delivered the RSNA 2016 Annual Oration in Radiation Oncology on prostate cancer research. “The rubber stamp approach is not in the patient’s best interest.”

In its statement, the USPSTF cites evidence from randomized clinical trials showing that PSA-based screening programs in men ages 55 to 69 years may prevent up to one to two deaths from prostate cancer over approximately 13 years per 1,000 men screening. Screening programs may also prevent up to three cases of metastatic prostate cancer per 1,000 men screened over 13 years.

But USPSTF also cites potential harms of PSA screening, including frequent false-positive results or overdiagnosis and overtreatment as well as treatment complications such as incontinence and impotence.

Dr. Lawton says a decision about prostate screening doesn’t have to be overly complicated.

“It’s actually pretty simple,” she said. “If you are an average 60- to 70-year-old healthy man, you should be screened for prostate cancer,” she said. “If you are an unhealthy man in that age group, you shouldn’t be screened. Nothing has changed in my thoughts about that.”

The guidelines are not final and remain open for public comment until May 8.

Web Extras

To access the USPSTF draft statement, go to https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/prostate-cancer-screening1