USPSTF changes 2012 recommendation on PSA testing

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Blood testing for prostate cancer now has a passing grade—the U.S. Preventative Services Task Force (USPSTF) has changed its tune on prostate-specific antigen (PSA) screening, upgrading the recommendation that some men undergo to a “C” grade. 

The USPSTF now advise individualized decisions for men ages 55 to 69 years old, where the panel had previously recommended men skip PSA testing altogether, giving the test a “D” grade for all age groups in 2012. USPSTF continues to recommend against screening for men 70 years or older.

“Screening offers a small potential benefit of reducing the chance of dying of prostate cancer,” said the USPSTF in a draft statement. “However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy, overdiagnosis and overtreatment, and treatment complications, such as incontinence and impotence.”

The change in heart was at least partially due to a recent European study, according to Alex Krist, MD, member of the task force and associate professor at Virginia Commonwealth University. The study found a substantial reduction in prostate cancer mortality when using PSA testing, but cautioned further research was needed to fully quantity screening-related harms and how best to reduce them.

The decision to get screened in the face of these negative externalities may be an easy one for high-risk populations, including black men and those with a family history of prostate cancer. However, the USPSTF urged all men to have a discussion with their physician about potential benefits and harms of PSA screening.

Prostate cancer is the third most-common cancer in the U.S. with about 180,000 cases and 26,000 deaths every year. While it makes up over 10 percent of new cancer cases, it accounts for just 4.4 percent of cancer deaths—with a five-year survival rate of 98.5 percent. Many of the deaths are caused by advanced stage cancers or occur in men ages 75 to 84 years old, where PSA testing can do more harm than good. 

The draft documents will be available for public comment until May 8.