Updated prostate cancer screening recommendations focus on patient preference

In an about face, the U.S. Preventive Services Task Force (USPSTF) has updated its recommendations on prostate cancer screening (PCa) after deciding the “net benefits” of screening these men for prostate cancer to be small.  However, the task force is endorsing that the prostate-specific antigen or PSA test should still be offered to men aged 55 to 69 after having a thorough conversation with their doctor on the harms and benefits of it.

But for men age 70 and older, the task force did not recommend PSA-based prostate cancer screening due to the higher likelihood of false positive results and additional risks associated with further diagnostic tests and treatments.  Older men may have more complications with biopsies and treatments such as surgery or radiation possibly making the risks outweighing the benefits of PSA screening for that age group.

The recommendations supporting screening of men ages 55 to 69 do align with the American Urological Association’s (AUA) clinical practice guideline and guidelines from most other major physician groups.  However, the AUA still supports screening of healthier men over the age of 70. 

With this updated revised guideline, more men could receive the PSA blood test for PCa as published in the Journal of the American Medical Association.  According to the USPSTF, there is “moderate certainty” of a “small” benefit of reducing death with screening of men in this age group.  Each year, more than 161,000 men receive a diagnosis of PCa and around 26,000 men will die from it.  This new revision may prevent 1.3 PCa deaths per 1000 men screened over 13 years. Another key component is that screening may also prevent 3 cases of metastatic PCa per 1000 men screened. 

The prostate is a gland of the male reproductive system that produces the fluid found in semen.  Prostate cancer refers to the unrestrained growth of certain cells in the gland.  The rate of growth varies dramatically between male patients.  For some men, the tumor grows very slowly and is unlikely to spread while in others, the tumor can grow rapidly becoming life-threatening.

The PSA test is a simple test that measures the amount of prostate specific antigen present in the blood and is used to screen for prostate cancer.  PSA is a protein that men have in their blood which is released by the prostate gland.  In healthy men, the amount of PSA is low – generally less than 4.0 ng/ml.  However, as men age, their prostate can experience physiological or pathological changes which cause the PSA to rise.

The reason for the change at this time is due to new evidence and research in the last 5 years suggesting screening can reduce mortality and reduce metastatic prostate cancer which is prostate cancer that has spread.  The recommendation is also recognizing that the benefits of prostate cancer screening can help identify and treat potentially lethal cases of PCa.  However, the task force also stated that some men may be harmed from PSA screening of potential unnecessary treatment.  This is why this revised recommendation highly encourages all men between the ages of 55 to 69, to discuss with their doctor to help them make the right individualized decision for them.  The idea is to have the discussion of the pros and cons of PSA screening helping educate men on making this important decision for them.

New data is also showing that more men are opting for “active surveillance” which has been used more in the last 5 years.  This has helped prevent the immediate decision to do more aggressive treatments such as surgery or radiation.  When using active surveillance, doctors do not treat the cancer but instead keep a watchful eye on it to make sure it doesn’t become aggressive.  At one time, only about 10 percent of men got active surveillance, and now in 2018 it’s closer to 40 percent. 

Even though news of this latest recommendation does provide some clarity on who should be screened, it also demonstrates the need for a better screening test for prostate cancer and improved treatments.  More research in this area, such as the potential use of MRIs and genetic testing to better detect aggressive prostate cancers, may be alternative, improved ways of detecting prostate cancer in the future.