The United States Preventive Services Task Force (USPSTF) today announced a change in its recommendations for prostate-specific antigen (PSA) screening. Based on a reanalysis of data from two large studies, it now recommends that men aged 55-69 make an informed, individual decision about whether to undergo screening. The task force’s previous recommendation, from 2012, discouraged use of PSA screening in any age group.
“This new recommendation is a positive step for men’s health. It preserves the benefits of early identification of prostate cancer, while reducing the harms of over-detection and over-treatment,” said Peter Carroll, MD, MPH, chair of UCSF Urology. Carroll commented on the new recommendation in an online editorial in JAMA Surgery.
The PSA —a simple blood test—was approved as a prostate cancer screening tool by the Food and Drug Administration (FDA) in 1994, but its widespread use has been controversial. A high PSA can trigger diagnostic and treatment procedures that carry risks to urinary and sexual function. Elevated levels can be a sign of prostate cancer, but other conditions, such as an enlarged prostate, can also affect PSA levels.
The earlier (2012) recommendation was based on an earlier interpretation of results from a European trial that showed a benefit in decreased prostate cancer deaths and a U.S. trial, which did not show that benefit. Reanalysis of these trials, including recognition of problems with the control arm of the U.S. study, suggest that both reached similar conclusions—PSA screening reduced prostate cancer mortality at least 25-32 percent.
“This change was based on a better understanding of the evidence supporting early detection and recognition that active surveillance, rather than treatment, of low-risk cancers was becoming much more common,” wrote Carroll in the JAMA Surgery editorial.
Optimal recommendations for screening high-risk groups, including African-American men and men with a family history of prostate cancer, as well as men of low socioeconomic status are unknown at present, but earlier testing is advised.
In his editorial, Carroll noted that the National Comprehensive Cancer Network panel on early detection of prostate cancer offers a still more refined screening strategy--one that considers testing as early as age 45.
Carroll called for further study of options other than prostate biopsy when PSA readings are over 2.5-3.0 ng/mL—the threshold range that most trials recommend be followed with biopsy to look for cancer cells. Carroll said other, non-invasive tests, such as urine and blood serum tests, and prostate magnetic resonance imaging (MRI) may provide similar information and are likely to be cost-effective in the long run if they prevent unnecessary biopsies and over detection.
(Image credit Cherise Hunter)