In a departure from earlier guidance, the US Preventive Services Task Force (USPSTF) has concluded that there is a small mortality benefit associated with prostate-specific antigen (PSA)-based prostate cancer screening for men aged 55 to 69 years,1
“justifying the offer of PSA testing selectively to men in this age group based on the judgment of the physician and the values of the patient.”
Table. USPSTF Updated Guidelines on PSA Testing
“The potential benefits and harms of screening for prostate cancer are closely balanced” in this age cohort, the authors stated. The task force gave the recommendation a C grade, meaning that there is moderate certainty that PSA screening produces a small net benefit in this patient population.
In reassessing the guidelines, reviewers sought to determine, among other issues, whether clear evidence exists that PSA screening reduces short- or long-term prostate cancer morbidity and mortality. They also sought to determine the harms of screening for prostate cancer and diagnostic follow-up. Their search for evidence led to a review of 303 full-text articles, a total that was augmented by 17 new articles since 2011.
"Fair Quality" Evidence
The task force included data from the European Randomized Study of Screening for Prostate Cancer (ERSPC); the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial; and the Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP), among others. Those trials, deemed “fair quality,” evaluated the PSA screening outcomes by prostate cancer morbidity, mortality, and all-cause mortality. The authors also included data from extended follow-up results in the ERSPC30 and PLCO29 trials.
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