Prostate screening is (almost) cool again.

For ages 55-69 from the USPSTF website: “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.”

 

This is a reverse of no PSA screening required.  More evidence shows that treatment will decrease risk of metastatic disease/extend life.  Active surveillance is being used more appropriately, as well.

The problem with the blanket statement of PSA not required in 2012 by this organization was the omission to continue to screen those as a higher risk of prostate cancer, i.e. family history/African American men.

From there American Urological Association in 2013 (they never abandoned PSA completely):

The target range for “routine” prostate-specific antigen screening has been narrowed to ages 55 to 69.

The American Urological Association (AUA) has published a new guideline on prostate-specific antigen (PSA) screening. The guideline has five summary recommendations:

  • No screening for men younger than 40.

  • No “routine” screening for men aged 40 to 54 and at average risk; for those in this age group who are at higher risk (e.g., black men, those with family histories of prostate cancer), individualize screening decisions.

  • For men aged 55 to 69, engage in shared decision making and proceed based on the man’s values and preferences.

  • No “routine” screening for men older than 70 or men with life expectancy shorter than 15 years.

  • When screening, consider biennial instead of annual screening.

Sounds like a familiar 2017 recommendation.

 

To summarize, if you are at average risk and between 55-69, PSA screening is again supported with patient education.

I am sure this will change again.


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