As indicated earlier this morning, the US Preventive Services Task Force (USPSTF) has issued new draft guidance on screening for risk of prostate cancer. Access to all the relevant details is provided below:
The new draft guidance now provides a level C recommendation with regard to screening for men in the age range of 55 to 69 years. The draft recommendation reads as follows:
The decision about whether to be screened for prostate cancer should be an individual one. The USPSTF recommends that clinicians inform men ages 55 to 69 years about the potential benefits and harms of prostate-specific antigen (PSA)–based screening for prostate cancer. Screening offers a small potential benefit of reducing the chance of dying of prostate cancer. However, many men will experience potential harms of screening, including false-positive results that require additional workup, overdiagnosis and overtreatment, and treatment complications such as incontinence and impotence. The USPSTF recommends individualized decisionmaking about screening for prostate cancer after discussion with a clinician, so that each man has an opportunity to understand the potential benefits and harms of screening and to incorporate his values and preferences into his decision.
However, the new draft guidance continues to recommend against screening for risk of prostate cancer among men of 70 years and older (a level D recommendation), stating simply that:
The USPSTF recommends against PSA-based screening for prostate cancer in men age 70 years and older.
The USPSTF has also put up a new, detailed web site that provides complete information for patients and their physicians designed to explain its thinking. This web site includes pages addressing all of the following:
- The detailed, 16-page-long recommendation issued by the USPSTF, which includes explicit and detailed subsections dealing with members of the African-American community and men with a family history of prostate cancer
- The complete evidence review on which the USPSTF recommendation is based
- An additional, contextual review addressing prostate cancer screening decision models and their accuracy
- An additional, contextual review addressing risk for over-diagnosis associated with prostate cancer screening decision models
The detailed guidance states clearly that
This recommendation applies to adult men in the general U.S. population without symptoms or a previous diagnosis of prostate cancer. It also applies to men at increased risk of death from prostate cancer due to race or family history of prostate cancer.
This recommendation does not apply to the use of the PSA test for surveillance after diagnosis or treatment of prostate cancer.
The detailed guidance also includes a specific and appropriate subsection on “Research Needs and Gaps” which, at a first glance, appear to be highly appropriate and accurate.
While there are certainly going to be some who are distressed by the continuing D recommendation for men of 70 years and older, our initial reaction is that the new draft guidance is a vastly improved and much more accurate assessment of the value and role of PSA testing than the guidance issued formally back in 2012, and if nothing else the USPSTF is to be congratulated on the thoroughness of its new review that has led to this set of new recommendations.